Clinical Characteristics of 20,662 Patients with COVID-19 in mainland China: A Systemic Review and Meta-analysis

  1. Chong Tang
  2. Keshi Zhang
  3. Wenlong Wang
  4. Zheng Pei
  5. Zheng Liu
  6. Ping Yuan
  7. Zhenpeng Guan
  8. Jin Gu

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Abstract

Coronavirus disease 2019 (COVID-19) is a global pandemic and has been widely reported; however, a comprehensive systemic review and meta-analysis has not been conducted. We systematically investigated the clinical characteristics of COVID-19 in mainland China to guide diagnosis and treatment. We searched the PubMed, Embase, Scopus, Web of Science, Cochrane Library, bioRxiv, medRxiv, and SSRN databases for studies related to COVID-19 published or preprinted in English or Chinese from January 1 to March 15, 2020. Clinical studies on COVID-19 performed in mainland China were included. We collected primary outcomes including signs and symptoms, chest CT imaging, laboratory tests, and treatments. Study selection, data extraction, and risk of bias assessment were performed by two independent reviewers. Qualitative and quantitative synthesis was conducted, and random-effects models were applied to pooled estimates. This study is registered with PROSPERO (number CRD42020171606). Of the 3624 records identified, 147 studies (20,662 patients) were analyzed. The mean age of patients with COVID-19 was 49.40 years, 53.45% were male, and 38.52% had at least one comorbidity. Fever and cough were the most common symptoms, followed by fatigue, expectoration, and shortness of breath. Most patients with COVID-19 had abnormal chest CT findings with ground glass opacity (70.70%) or consolidation (29.91%). Laboratory findings shown lymphopenia, increased lactate dehydrogenase, increased infection-related indicators, and fibrinolytic hyperactivity. Antiviral therapy, antibiotic therapy, and corticosteroids were administered to 89.75%, 79.13%, and 35.64% of patients, respectively. Most clinical characteristics of COVID-19 are non-specific. Patients with suspected should be evaluated by virological assays and clinically treated.

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  1. ScreenIT

    SciScore for 10.1101/2020.04.18.20070565: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategy and selection criteria: For this systematic review and a meta-analysis, we searched the PubMed, Embase, Scopus, Web of Science, Cochrane Library, bioRxiv, medRxiv, and SSRN electronic databases for papers published or preprinted in English or Chinese from January 1 to March 15, 2020 with the following search terms: “coronavirus disease 2019” OR “COVID-19” OR “SARS-CoV-2” OR “2019-nCoV” OR “Novel Coronavirus” OR “Wuhan pneumonia”.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    Cochrane Library
    suggested: (Cochrane Library, RRID:SCR_013000)
    bioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study had both strengths and limitations. This meta-analysis is the most comprehensive assessment and robust evidence to date of the clinical characteristics of patients with COVID-19 in mainland China. We evaluated 147 published and preprinted studies involving 20,662 patients, equivalent to a quarter of all confirmed cases in mainland China and reflecting the clinical characteristics of patients with COVID-19.6 There were some limitations to our study. First, this study was retrospective, and most studies were preprinted articles that had not been peer-reviewed, leading to a moderate overall quality of the literature. Second, not all clinical characteristics were well-documented, such as chest CT or laboratory tests, leading to inconsistencies in the total number of each item calculated. This also led to heterogeneity. Third, all included cases were treated from December 2019 to February 2020, and many were reported by several hospitals in Wuhan, Hubei province. There may be repeated reports of some cases, leading to a significant heterogeneity and obvious publication bias. To overcome these issues, we used random effects for meta-analysis, meta-regression tests, and Egger’s test. Finally, we were unable to determine the incubation period of COVID-19 because of the heterogeneity among studies in reporting the timeline of cases. In summary, COVID-19 is an emerging infectious disease with various clinical manifestations. The morbidity of COVID-19 is not age- and sex-depe...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.04.18.20070565 on medRxiv