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

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, I 2 , T 2 , 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 ( I 2 ; 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.

Pathogenesis‐directed therapy of 2019 novel coronavirus disease

“…The severity of the alveolar infection may be related to the ratio of membrane‐bound and soluble ACE2 in the lungs 116 . Infection by SARS‐CoV‐2 is more severe in persons with pre‐existing ACE2 deficiency as seen in older persons as well as those with hypertension, diabetes, and cardiovascular disease 13–17 . SARS‐CoV‐2 invasion of tissue causes further downregulation of ACE2, which then facilitates the progression of inflammatory and hyper‐coagulation processes 112,113 .…”

“…The 2019 novel coronavirus disease (COVID‐19) outbreak in Wuhan, China began as a mystery 1 and now is considered a global public health emergency with many unprecedented challenges as well as important economic, political, and epidemiological implications 2–7 . Among the key challenges is defining optimal therapies for COVID‐19 patients with severe pneumonia and complex systemic manifestations, 8–15 particularly those with known comorbidities (Table 1). 11–17 …”

“…Among the key challenges is defining optimal therapies for COVID‐19 patients with severe pneumonia and complex systemic manifestations, 8–15 particularly those with known comorbidities (Table 1). 11–17 …”

Impact of COVID-19 Pandemic on Pediatrics and Pediatric Transplantation Programs

“…Metanalyses of the published literature in adults and pediatric patients infected with SARS-CoV-2 have identified a number of medical conditions correlating with disease severity and being admitted to the intensive care setting (12)(13)(14). Some of the factors identified include diabetes, hypertension, coronary artery disease/cardiovascular disease, chronic pulmonary disease, malignancy, chronic kidney disease, older age and male gender although the heterogeneity between studies varied substantially.…”

What could explain the late emergence of COVID-19 in Africa?

“…Asymptomatic infection can occur at any age, but had a higher prevalence in patients under 45 years old compared with symptomatic people [ 6 ]. In a meta-analysis, the most frequent clinical signs and symptoms reported in symptomatic patients were fever (78.5%), cough (53.8%) and fatigue (25.0%), and 6.8% of the patients were admitted to the intensive care unit and 7.7% died during hospitalization due to complications related to COVID-19 (pneumonia, secondary bacterial infection and respiratory failure) [ 7 ].…”