Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2: A systematic review and meta-analysis

Yinghao Cao, Xiaoling Liu, Lijuan Xiong, Kailin Cai, Yinghao Cao, Xiaoling Liu, Lijuan Xiong, Kailin Cai

Abstract

Background: Currently, the epidemic of coronavirus disease 2019 (COVID-19) has begun to spread worldwide. We aim to explore reliable evidence for the diagnosis and treatment of the COVID-19 by analyzing all the published studies by Chinese scholars on the clinical and imaging features in novel coronavirus pneumonia caused by SARS-CoV-2.

Methods: We searched five medical databases including two Chinese and three English databases for all published articles on COVID-19 since the outbreak. A random-effects model was designed, and the imaging and clinical data from all studies were collected for meta-analysis.

Results: Overall, 31 articles and 46 959 patients were included, including 10 English articles and 21 Chinese articles. The results of meta-analysis showed that the most common clinical manifestations were fever (87.3%; 0.838-0.909), cough (58.1%; 0.502-0.660), dyspnea (38.3%; 0.246-0.520), muscle soreness or fatigue (35.5%; 0.253-0.456), and chest distress (31.2%; -0.024 to 0.648). The main imaging findings were bilateral pneumonia (75.7%; 0.639-0.871) and ground-glass opacification (69.9%; 0.602-0.796). Among the patients, the incidence that required intensive care unit (ICU) was (29.3%; 0.190-0.395), the incidence with acute respiratory distress syndrome was (28.8%; 0.147-0.429), the incidence with multiple organ dysfunction syndrome was (8.5%; -0.008 to 0.179), and the case fatality rate of patients with COVID-19 was (6.8%; 0.044-0.093).

Conclusion: COVID-19 is a new clinical infectious disease that mainly causes bilateral pneumonia and lung function deteriorates rapidly. Nearly a third of patients need to be admitted to the ICU, and patients are likely to present respiratory failure or even death.

Keywords: 2019 novel coronavirus pneumonia; SARS-CoV-2; clinical features; imaging finding.

Conflict of interest statement

The authors declare that there are no conflict of interests.

© 2020 Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
Diagram of documents retrieval
Figure 2
Figure 2
The forest plots of age and sex. A, age and (B) sex
Figure 3
Figure 3
The forest plots of the incidence of comorbidities and intensive care unit (ICU). A, Comorbidities; (B) tumor; (C) diabetes; (D) hypertension; (E) cardiovascular disease; (F) phthisis; (G) chronic obstructive pulmonary disease; (H) chronic hepatonephropathy; (I) ICU
Figure 4
Figure 4
The forest plots of the incidence of clinical features. A, Fever; (B) cough; (C) sore throat; (D) expectoration; (E) chest distress; (F) muscle soreness or fatigue; (G) headache; (H) diarrhea; (I) dyspnea
Figure 5
Figure 5
The forest plots of the incidence of laboratory test features. A, Leukocytosis; (B) leukopenia; (C) lymphocytopenia; (D) high C‐reactive protein; (E) high lactate dehydrogenase; (F) high erythrocyte sedimentation rate
Figure 6
Figure 6
The forest plots of the incidence of imaging features. A, Unilateral; (B) bilateral; (C) lung consolidation; (D) ground‐glass; (E) air bronchogram; (F) grid‐form shadow; (G) bronchovascular bundles thickening; (H) hydrothorax; (I) irregular or halo sign
Figure 7
Figure 7
The forest plots of the incidence of complication. A, acute respiratory distress syndrome; (B) acute cardiac injury; (C) acute renal injury; (D) shock; (E) multiple organ dysfunction syndrome; (F) mortality

References

    1. Xu X, Chen P, Wang J, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020;63(3):457‐460.
    1. Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus‐infected pneumonia. N Engl J Med. 2020;382(13):1199‐1207.
    1. Zhou P, Yang X, Wang X, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270‐273.
    1. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID‐19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420‐422.
    1. Institute of Health Economics . Quality Appraisal of Case Series Studies Checklist; 2014.
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497‐506.
    1. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020;395(10223):507‐513.
    1. Chung M, Bernheim A, Mei X, et al. CT imaging features of 2019 novel coronavirus (2019‐nCoV). Radiology. 2020;295(1):202‐207.
    1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus‐infected pneumonia in Wuhan, China. JAMA. 2020;233(3):104‐105.
    1. Liu K, Fang Y, Deng Y, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J. 2020;3(4):1.
    1. Chang D, Lin M, Wei L, et al. Epidemiologic and clinical characteristics of novel coronavirus infections involving 13 patients outside Wuhan, China. JAMA. 2020;323(11):1092‐1093.
    1. Zheng YY, Ma X, Wang HY, et al. Computed tomography features of patients with novel coronavirus pneumonia. Shanghai Med J. 2020;43(2):1‐10.
    1. Liu YX, Yang Y, Zhang C, et al. Clinical and biochemical indexes from 2019‐nCoV infected patients linked to viral loads and lung injury (Chinese). Sci China Life Sci. 2020;50(3):258‐269.
    1. Gao L, Zhang JP, Du YH, et al. CT features of patients with imported 2019‐nCoV‐pneumonia. J Xi'an Jiaotong Univ (Med Sci) 2020;41(2):187.
    1. Gong XM, Li H, Song L, et al. Preliminary explore on CT characteristics of coronavirus disease 2019 (COVID‐19). Radiol Prac. 2020;35(3):261‐265.
    1. Pan Y, Guan H, Zhou S, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019‐nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020;133(21):146.
    1. Liu Y, Zhang D, Tang S, et al. The epidemiological and clinical characteristics of 2019 novel coronavirus infection in Changsha, China. Preprint Lancet. 2020;50(2):342‐346.
    1. Pan F, Ye T, Sun P, et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID‐19) pneumonia. Radiology. 2020;35(1):200370.
    1. Zhang MQ, Wang XH, Chen YL, et al. Clinical features of 2019 novel coronavirus pneumonia in the early stage from a fever clinic in Beijing. Zhonghua Jiehe He Huxi Zazhi. 2020;43(0):E013.
    1. Feng K, Yun YX, Wang XF, et al. Analysis of CT features of 15 children with 2019 novel coronavirus infection. Chin J Pediatr. 2020;58(3):E007.
    1. Wang XF, Yuan J, Zheng YJ, et al. Retracted: Clinical and epidemiological characteristics of 34 children with 2019 novel coronavirus infection in Shenzhen. Chin J Pediatr. 2020;58(1):E008.
    1. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team . The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID‐19) in China. J. Chin Epi. 2020;41(2):145‐151.
    1. Liu FM, Ding HL, Gong XM, et al. Chest CT performance and clinical characteristics of coronavirus disease 2019 (COVID‐19). Radiol Prac. 2020;35(3):266‐268.
    1. Zhuang YJ, Chen Z, Li J. Clinical and epidemiological characteristics of 26 patients dia gnosed with novel coronavirus pneumonia. Chin J Nosocomiology. 2020;23(6):826‐829.
    1. Wang K, Kang SR, Tian RH, et al. CT characteristic appearances of patients with novel coronavirus pneumonia. J Clin Med. 2020;1(27):27‐31.
    1. Chen M, An W, Xia F, et al. Retrospective analysis of COVID‐19 patients with different clinical subtypes. Herald Med. 2020;41(5):1‐12.
    1. Zhong FY, Zhang HF, Wang BC, et al. CT findings in 2019 novel coronavirus disease (COVID‐19) patients. Med J Wuhan Univ. 2020;31(1):1‐5.
    1. Fu GZ, Xu CY, Sun HC, et al. Application of chest CT examination in screening of patients with novel coronavirus pneumonia. Med J Wenzhou Univ. 2020;20(2):1‐9.
    1. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS‐CoV‐2 pneumonia in Wuhan, China: a single‐centered, retrospective, observational study. Lancet Respir Med. 2020;8(4):E26.
    1. Ji GH, Huang MH, Zhang Q, et al. CT manifestations and dynamic changes of coronavirus disease 2019. Chin J Med Imaging Technol. 2020;36(2):242‐247.
    1. Chen L, Feng SY, Wang FX, et al. Clinical diagnosis and treatment of critical patients with novel coronavirus pneumonia (report of 12 cases). J Clin Med. 2020;27(1):32‐35.
    1. Zeng GF, Yang HP, Zhang XY, et al. Analysis of clinical and imaging features of novel coronavirus pneumonia in Chongqing traditional Chinese medicine system. J Emerg Tradit Chin Med. 2020;29(3):377‐380.
    1. Cao J, Zhou J, Liao XN, et al. Clinical characteristics and CT signs of coronavirus disease 2019 (COVID‐19) in the elderly. Med J Wuhan Univ. 2020;4(2):1‐4.
    1. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;213(42):543‐546.
    1. Yu XT, Ye H, Yang SF, et al. Chest CT features of COVID‐19. J Pract Med. 2020;2(3):1‐3.
    1. Chen L, Liu HG, Liu W, et al. Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia. Chin J Tuberc Respir Dis. 2020;43(0):E005.
    1. Special Expert Group for Control of the Epidemic of Novel Coronavirus Pneumonia of the Chinese Preventive Medicine . An update on the epidemiological characteristics of novel coronavirus pneumonia (COVID‐19). J. Chin Epi. 2020;41(2):139.
    1. Liu Q, Wang RS, Qu GQ, et al. Systematic solution of new coronavirus pneumonia in dead cadavers. J Forensic Sci. 2020;36(1):19‐21.
    1. Guan GW, Gao L, Wang JW, et al. Study on the mechanism of liver enzyme abnormality in pneumonia infected by novel coronavirus. J Hepatol. 2020;28(2):E002.
    1. Li F. Structure, function, and evolution of coronavirus spike proteins. Annu Rev Virol. 2016;3(1):237‐261.
    1. Bj B, van der Zee R, de Haan CA, Rottier PJ. The coronavirus spike protein is a class I virus fusion protein: structural and functional characterization of the fusion core complex. J Virol. 2003;77(16):8801‐8811.
    1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727‐733.
    1. Chu DKW, Pan Y, Cheng SMS, et al. Molecular diagnosis of a novel coronavirus (2019‐nCoV) causing an outbreak of pneumonia. Clin Chem. 2020;66(4):549‐555.
    1. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT‐PCR testing in coronavirus disease 2019 (COVID‐19) in China: a report of 1014 cases. Radiology. 2020;24(3):200642.
    1. Boldog P, Tekeli T, Vizi Z, Dénes A, Bartha FA, Röst G. Risk assessment of novel coronavirus COVID‐19 outbreaks outside China. J Clin Med. 2020;9(2):571.
    1. Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019‐nCoV outbreak originating in Wuhan, China: a modelling study. The Lancet. 2020;395(10225):689‐697.
    1. Sands P, Mundaca‐Shah C, Dzau VJ. The neglected dimension of global security—a framework for countering infectious‐disease crises. N Engl J Med. 2016;374(13):1281‐1287.

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