Zhang John J Y, Lee Keng Siang, Ang Li Wei, Leo Yee Sin, Young Barnaby Edward
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom.
Clin Infect Dis. 2020 Nov 19;71(16):2199-2206. doi: 10.1093/cid/ciaa576.
The coronavirus disease 2019 (COVID-19) pandemic spread globally in the beginning of 2020. At present, predictors of severe disease and the efficacy of different treatments are not well understood. We conducted a systematic review and meta-analysis of all published studies up to 15 March 2020, which reported COVID-19 clinical features and/or treatment outcomes. Forty-five studies reporting 4203 patients were included. Pooled rates of intensive care unit (ICU) admission, mortality, and acute respiratory distress syndrome (ARDS) were 10.9%, 4.3%, and 18.4%, respectively. On meta-regression, ICU admission was predicted by increased leukocyte count (P < .0001), alanine aminotransferase (P = .024), and aspartate transaminase (P = .0040); elevated lactate dehydrogenase (LDH) (P < .0001); and increased procalcitonin (P < .0001). ARDS was predicted by elevated LDH (P < .0001), while mortality was predicted by increased leukocyte count (P = .0005) and elevated LDH (P < .0001). Treatment with lopinavir-ritonavir showed no significant benefit in mortality and ARDS rates. Corticosteroids were associated with a higher rate of ARDS (P = .0003).
2019年冠状病毒病（COVID-19）大流行于2020年初在全球蔓延。目前，对于重症疾病的预测指标以及不同治疗方法的疗效尚不清楚。我们对截至2020年3月15日发表的所有报告COVID-19临床特征和/或治疗结果的研究进行了系统评价和荟萃分析。纳入了45项报告4203例患者的研究。重症监护病房（ICU）收治率、死亡率和急性呼吸窘迫综合征（ARDS）的合并率分别为10.9%、4.3%和18.4%。在meta回归分析中，白细胞计数升高（P <.0001）、丙氨酸转氨酶（P =.024）和天冬氨酸转氨酶（P =.0040）可预测ICU收治情况；乳酸脱氢酶（LDH）升高（P <.0001）；降钙素原升高（P <.0001）。LDH升高（P <.0001）可预测ARDS，而白细胞计数升高（P =.0005）和LDH升高（P <.0001）可预测死亡率。洛匹那韦-利托那韦治疗在死亡率和ARDS发生率方面未显示出显著益处。皮质类固醇与较高的ARDS发生率相关（P =.0003）。
