Prevalence and correlation of symptoms and comorbidities in COVID-19 patients: A systematic review and meta-analysis

  1. Mohammad Meshbahur Rahman
  2. Badhan Bhattacharjee
  3. Zaki Farhana
  4. Mohammad Hamiduzzaman
  5. Muhammad Abdul Baker Chowdhury
  6. Mohammad Sorowar Hossain
  7. Mahbubul H Siddiqee
  8. Md. Ziaul Islam
  9. Enayetur Raheem
  10. Md. Jamal Uddin

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Abstract

Background

The COVID-19 affected millions of people, and the patients present a constellation of symptoms and comorbidities. We aimed to chronicle the prevalence and correlations of symptoms and comorbidities, and associated covariates among the patients.

Methods

We performed a systematic review and meta-analysis [PROSPERO registration: CRD42020182677]. Databases [PubMed, SCOPUS, EMBASE, WHO, Semantic Scholar, and COVID-19 Primer] were searched for clinical studies published in English from January 1 to April 20, 2020. The pooled prevalence of symptoms and comorbidities were identified using the random effect model, and sub-groups analysis of patients’ age and locations were investigated. A multivariable factor analysis was also performed to show the correlation among symptoms, comorbidities and age of the COVID-19 patients.

Findings

Twenty-nine articles [China (24); Outside of China (5)], with 4,884 COVID-19 patients were included in this systematic review. The meta-analysis investigated 33 symptoms, where fever [84%], cough/dry cough [61%], and fatigue/weakness [42%] were found frequent. Out of 43 comorbidities investigated, acute respiratory distress syndrome (ARDS) [61%] was a common condition, followed by hypertension [23%] and diabetes [12%]. According to the patients’ age, the prevalence of symptoms like fatigue/weakness, dyspnea/shortness of breath, and anorexia were highly prevalent in older adults [≥50 years] than younger adults [≤50 years]. Diabetes, hypertension, coronary heart disease, and COPD/lung disease were more prevalent comorbidities in older adults than younger adults. The patients from outside of China had significantly higher prevalence [p< 0.005] of diarrhea, fatigue, nausea, sore throat, and dyspnea, and the prevalent comorbidities in that region were diabetes, hypertension, coronary heart disease, and ARDS. The multivariable factor analysis showed positive association between a group of symptoms and comorbidities, and with the patients’ age.

Interpretation

Epitomizing the correlation of symptoms of COVID-19 with comorbidities and patients’ age would help clinicians effectively manage the patients.

Summary box

    What is already known?

  • There is scarce evidence on the prevalence of all symptoms and comorbidities in COVID-19 infected older adults and patients from outside of China.

  • Previously published review studies excluded a wide range of symptoms and comorbidities from their analysis due to limited time-frame.

  • Study on the correlation of symptoms and comorbidity with age of the COVID-19 patients are not yet to be explored.

    What are the new findings?

  • We investigated all the reported symptoms [33] and comorbidity [43] where fever [84%], cough/dry cough [61%], fatigue/weakness [42%] and dyspnea/shortness of breath [ symptoms, and ARDS [61%], followed by hypertension [23%] and frequent comorbidity.

  • Key findings, the fatigue/weakness, dyspnea/shortness of breath and anorexia were comparatively higher in older adults than younger adults, and the patients from outside of China had a higher prevalence diarrhoea, fatigue, nausea, sore throat, dyspnea, diabetes, hypertension, coronary heart disease and ARDS.

  • Key findings, the symptoms comprising fever, dyspnea/shortness of breath, nausea, vomiting, abdominal pain, dizziness, anorexia and pharyngalgia; and the comorbidities including diabetes, hypertension, coronary heart disease, COPD/lung disease and ARDS were positively correlated with the COVID-19 patient’s age.

    What do the new findings imply?

  • These findings according to patient’s age and geographical variations may help the health care providers and policy makers.

  • This pioneering efforts in estimating the prevalence and correlations of all frequent symptoms and comorbidities will help the clinicians and disease practitioners like WHO to implement patient-centered interventions.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.08.19.20177980: (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 variableStudies were excluded if they were: grey literature, case report and secondary studies; specific to children or pregnant women; and only reported symptoms or comorbidities.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    10 The major databases, such as PubMed, SCOPUS, EMBASE, WHO, Semantic Scholar, and COVID-19 Primer were searched to include peer-reviewed and pre-proof research articles.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    Semantic Scholar
    suggested: (VideoLectures.NET, RRID:SCR_001972)
    Some articles were manually retrieved from Google Scholar and other databases.
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    Multivariate analysis [multivariable factor analysis (MFA)] was performed to examine the correlation among symptoms and comorbidities with the patients’ age.14,15 All statistical analyses were conducted by Stata version 15 (Stata Corp, College Station, TX) using the metaprop, metabias, metafunnel commands, and R-programming language using the FactoMineR package.
    FactoMineR
    suggested: (FactoMineR, RRID:SCR_014602)

    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:
    Limitation of the Study: During literature search, our selected studies confirmed almost hundred present of the COVID-19 symptoms except the loss of taste or smell and we were limited to only in English texts within the time frame January to April 20, 2020. The majority of the studies were found in China, and only five from other countries. More studies outside of China could add value in prevalence estimation. We found no data for <10 years children and thus, more studies are warranted in the child COVID-19 patients. Lastly, a few studies were found low sample size.

    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 10.1101/2020.08.19.20177980v2 on medRxiv
  3. Version published to 10.1101/2020.08.19.20177980v1 on medRxiv