Comorbidities, clinical signs and symptoms, laboratory findings, imaging features, treatment strategies, and outcomes in adult and pediatric patients with COVID-19: A systematic review and meta-analysis

Catherine R Jutzeler; Lucie Bourguignon; Caroline V Weis; Bobo Tong; Cyrus Wong; Bastian Rieck; Hans Pargger; Sarah Tschudin-Sutter; Adrian Egli; Karsten Borgwardt; Matthias Walter

doi:10.1016/j.tmaid.2020.101825

Comorbidities, clinical signs and symptoms, laboratory findings, imaging features, treatment strategies, and outcomes in adult and pediatric patients with COVID-19: A systematic review and meta-analysis

Travel Med Infect Dis. 2020 Sep-Oct:37:101825. doi: 10.1016/j.tmaid.2020.101825. Epub 2020 Aug 4.

Authors

Affiliations

¹ Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. Electronic address: Catherine.Jutzeler@bsse.ethz.ch.
² Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.
³ International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.
⁴ Simon Fraser University, Vancouver, Canada.
⁵ Intensive Care Unit, University Hospital Basel, University Basel, Basel, Switzerland.
⁶ Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel and University of Basel, Switzerland; Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland.
⁷ Division of Clinical Bacteriology & Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.
⁸ Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada; Swiss Paraplegic Center, Nottwil, Switzerland.

Abstract

Introduction: Since December 2019, a novel coronavirus (SARS-CoV-2) has triggered a world-wide pandemic with an enormous medical and societal-economic toll. Thus, our aim was to gather all available information regarding comorbidities, clinical signs and symptoms, outcomes, laboratory findings, imaging features, and treatments in patients with coronavirus disease 2019 (COVID-19).

Methods: EMBASE, PubMed/Medline, Scopus, and Web of Science were searched for studies published in any language between December 1st, 2019 and March 28th, 2020. Original studies were included if the exposure of interest was an infection with SARS-CoV-2 or confirmed COVID-19. The primary outcome was the risk ratio of comorbidities, clinical signs and symptoms, laboratory findings, imaging features, treatments, outcomes, and complications associated with COVID-19 morbidity and mortality. We performed random-effects pairwise meta-analyses for proportions and relative risks, I², T², and Cochrane Q, sensitivity analyses, and assessed publication bias.

Results: 148 studies met the inclusion criteria for the systematic review and meta-analysis with 12'149 patients (5'739 female) and a median age of 47.0 [35.0-64.6] years. 617 patients died from COVID-19 and its complication. 297 patients were reported as asymptomatic. Older age (SMD: 1.25 [0.78-1.72]; p < 0.001), being male (RR = 1.32 [1.13-1.54], p = 0.005) and pre-existing comorbidity (RR = 1.69 [1.48-1.94]; p < 0.001) were identified as risk factors of in-hospital mortality. The heterogeneity between studies varied substantially (I²; range: 1.5-98.2%). Publication bias was only found in eight studies (Egger's test: p < 0.05).

Conclusions: Our meta-analyses revealed important risk factors that are associated with severity and mortality of COVID-19.

Keywords: COVID-19; Clinical characteristics; Comorbidities; Imaging features; Laboratory findings; Meta-analysis; Outcomes; SARS-CoV-2; Systematic review; Treatment.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Aging*
Betacoronavirus*
COVID-19
Comorbidity
Coronavirus Infections / diagnostic imaging*
Coronavirus Infections / mortality
Coronavirus Infections / therapy*
Humans
Pandemics
Pneumonia, Viral / diagnostic imaging*
Pneumonia, Viral / mortality
Pneumonia, Viral / therapy*
Risk Factors
SARS-CoV-2