Clinical, laboratory and radiological characteristics and outcomes of novel coronavirus (SARS-CoV-2) infection in humans: A systematic review and series of meta-analyses

Abstract

New evidence on the COVID-19 pandemic is being published daily. Ongoing high-quality assessment of this literature is therefore needed to enable clinical practice to be evidence-based. This review builds on a previous scoping review and aimed to identify associations between disease severity and various clinical, laboratory and radiological characteristics. We searched MEDLINE, CENTRAL, EMBASE, Scopus and LILACS for studies published between January 1, 2019 and March 22, 2020. Clinical studies including ≥10 patients with confirmed COVID-19 of any study design were eligible. Two investigators independently extracted data and assessed risk of bias. A quality effects model was used for the meta-analyses. Subgroup analysis and meta-regression identified sources of heterogeneity. For hospitalized patients, studies were ordered by overall disease severity of each population and this order was used as the modifier variable in meta-regression. Overall, 86 studies (n = 91,621) contributed data to the meta-analyses. Severe disease was strongly associated with fever, cough, dyspnea, pneumonia, any computed tomography findings, any ground glass opacity, lymphocytopenia, elevated C-reactive protein, elevated alanine aminotransferase, elevated aspartate aminotransferase, older age and male sex. These variables typically increased in prevalence by 30–73% from mild/early disease through to moderate/severe disease. Among hospitalized patients, 30–78% of heterogeneity was explained by severity of disease. Elevated white blood cell count was strongly associated with more severe disease among moderate/severe hospitalized patients. Elevated lymphocytes, low platelets, interleukin-6, erythrocyte sedimentation rate and D-dimers showed potential associations, while fatigue, gastrointestinal symptoms, consolidation and septal thickening showed non-linear association patterns. Headache and sore throat were associated with the presence of disease, but not with more severe disease. In COVID-19, more severe disease is strongly associated with several clinical, laboratory and radiological characteristics. Symptoms and other variables in early/mild disease appear non-specific and highly heterogeneous. Clinical Trial Registration: PROSPERO CRD42020170623 .

Susceptibility of the patients infected with Sars-Cov2 to oxidative stress and possible interplay with severity of the disease

“…There are no reports on the identification of oxidative stress markers in COVID-19 infected patients and whether there are differences in the moderate and severe redox profiles.In this prospective cohort, major symptoms presented in patients admitted to hospital facilities with COVID-19 were fever, cough, and dyspnea. Fever has been reported to be more common in moderate/severe patients (89%) than in mild patients (77%) [ 29 ]. However, there is considerable heterogeneity in fever symptoms if evaluated in the early phase of COVID-19 (32-95%) [ 29 ].…”

Journey to a Receptor for Advanced Glycation End Products Connection in Severe Acute Respiratory Syndrome Coronavirus 2 Infection

“… 10 SARS-CoV-2 may directly infect human cardiomyocytes. 11 Beyond the indirect effects to the heart consequent to the severe respiratory consequences 12 and the yet-to-be-fully explained disorders of coagulation, exemplified in part by high levels of the D-dimer, 13 , 14 extensive damage to the heart may ensue from direct infection through necrosis and myocarditis. 9 …”

Decoding Covid-19 with the SARS-CoV-2 Genome

“…Disease severity is also variable but can be fatal for individuals with underlying health conditions and so-called long Covid, where following recovery from acute disease, many ongoing effects are prevalent [ 16 ]. While the true death rate of SARS-CoV-2 cannot be calculated during an ongoing pandemic, it is estimated to be approximately 1%, with the majority of fatalities occurring in individuals over 60 years old, those who are immune-compromised or those with pre-existing conditions that are worsened by the effects of Covid-19 disease [ 17 ].…”