Clinical symptoms, comorbidities and complications features in severe and non-severe patients with COVID-19: a systematic review and meta-analysis without cases duplication

Abstract

Background: The pandemic of COVID-19 posed a challenge to global healthcare. The mortality rates of severe cases range from 8.1% to 31.8%, and it is particularly important to identify risk factors that aggravate the disease.Methods: We performed a systematic review of the literature with meta-analysis, using 7 databases to assess clinical characteristics, comorbidities and complications in severe and non-severe patients with COVID-19. All the observational studies were included. We performed a random or fixed effects model meta-analysis to calculate the pooled proportion and 95% CI. Measure of heterogeneity was estimated by Cochran’s Q statistic, I2 index and P value.Results: 4881 cases from 25 studies related to COVID-19 were included. The most prevalent comorbidity was hypertension (severe: 33.4%, 95% CI: 25.4% - 41.4%; non-severe 21.6%, 95% CI: 9.9% - 33.3%), followed by diabetes (severe: 14.4%, 95% CI: 11.5% - 17.3%; non-severe: 8.5%, 95% CI: 6.1% - 11.0%). The prevalence of ARDS, AKI and shock were all higher in severe cases, with 41.1% (95% CI: 14.1% - 68.2%), 16.4% (95% CI: 3.4% - 29.5%) and 19.9% (95% CI: 5.5% - 34.4%), rather than 3.0% (95% CI: 0.6% - 5.5%), 2.2% (95% CI: 0.1% - 4.2%) and 4.1% (95% CI -4.8% - 13.1%) in non-severe patients, respectively. The death rate was higher in severe cases (30.3%, 95% CI: 13.8% - 46.8%) than non-severe cases (1.5%, 95% CI: 0.1% - 2.8%).Conclusions: Hypertension, diabetes and cardiovascular diseases may be risk factors for COVID-19 patients to develop into severe cases.

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – A narrative review

“…In a recent analysis of 25 studies, including 4881 severe and nonsevere COVID-19 cases [ 9 ], key prevalent comorbidities of infected patients were hypertension (prevalence of about 33% vs. 22% in severe versus nonseverely affected patients) and diabetes (prevalence of about 14% vs. 9% in severe versus nonseverely affected patients) [ 9 ]. As expected, the prevalence of CARDS (about 41% vs. 3%) and/or acute kidney injury (AKI; about 16% vs. 2%) and/or shock (about 20% vs. 4%) were all increased in severe vs. nonsevere cases (mortality of about 30% in severe cases) [ 9 ].…”

“…In a recent analysis of 25 studies, including 4881 severe and nonsevere COVID-19 cases [ 9 ], key prevalent comorbidities of infected patients were hypertension (prevalence of about 33% vs. 22% in severe versus nonseverely affected patients) and diabetes (prevalence of about 14% vs. 9% in severe versus nonseverely affected patients) [ 9 ]. As expected, the prevalence of CARDS (about 41% vs. 3%) and/or acute kidney injury (AKI; about 16% vs. 2%) and/or shock (about 20% vs. 4%) were all increased in severe vs. nonsevere cases (mortality of about 30% in severe cases) [ 9 ]. Another investigation identified advanced age, male gender, underlying comorbidities, including hypertension, diabetes, obesity, chronic obstructive lung disease, cardiac, hepatic and/or renal disease, malignancy, immunodeficiency, and pregnancy as key risk factors for the progression of COVID-19 to severe, i.e., critical disease [ 27 ].…”

“…Most often, viral COVID-19-associated pneumonia is acquired in the community with severe courses often observed in older patients and those with significant comorbidities [ [9] , [10] , [11] ]. In a recent systematic review of 152 studies, clinical manifestations (particularly in younger populations without comorbidities [ [11] , [12] , [13] ]) mostly included mild symptoms such as fever, cough/secretions, dyspnea, and malaise/fatigue [ 14 ].…”

Impact of both socioeconomic level and occupation on antibody prevalence to SARS‐CoV‐2 in an Egyptian cohort: The first episode

“…On the other hand, heterogeneity in the symptoms and disease severity due to acquiring SARS‐CoV‐2 infection is quite broad and ranges from mild or no symptoms to severe illness with uncontrollable health eterioration 5 that ends up with case fatality rates ranging from 4.2% 6 to >6.7% 7 …”

Letter to the editor: Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study

“…Yet this information was lacking. For example, we could not identify the rationale for testing cough exercise in all the patients involved, considering that sputum production seems to be a clinical feature in only about 30% of individuals with COVID-19 [ 8 , 9 ]. Liu and collaborators based the background of their study on research conducted in individuals with Parkinson's disease hospitalized for pneumonia [ 10 ] and on research conducted in individuals with musculoskeletal disorders, without respiratory diseases [ 11 ].…”