Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Respiratory and Critical Care Medicine, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Nanjing, China.
Ann Palliat Med. 2021 Feb;10(2):1928-1949. doi: 10.21037/apm-20-1863. Epub 2021 Jan 27.
The coronavirus disease 2019 (COVID-19) is an emerging pandemic of global public health concern. We aimed to summarize the characteristics of COVID-19 patients in the early stage of the pandemic and explore the risk factors of disease progression.
We conducted a systematic review with meta-analysis, searching three databases for studies published between January 1, 2020, and March 18, 2020. We used random-effects models to calculate the 95% confidence intervals of pooled estimated prevalence and the odds ratio between the severe and nonsevere cases.
Ninety studies involving 16,526 COVID-19 patients were included. Hypertension (19.1%) and diabetes (9.5%) were the most common comorbidities. The most prevalent clinical symptoms were fever (78.4%), cough (58.5%), and fatigue (26.4%). Increased serum ferritin (74.2%), high C-reactive protein (73.3%), and high erythrocyte sedimentation rate (ESR) (72.2%) were the most frequently reported laboratory abnormalities. Most patients had bilateral lung involvement (82.2%) and showed peripheral (66.9%) and subpleural (62.1%) distribution, with multifocal involvement (73.1%). And the most common CT features were vascular enlargement (64.3%), ground-glass opacity (GGO) (60.7%), and thickened interlobular septa (55.1%). Respiratory failure was the most common complication (30.7%) and the overall case-fatality rate (CFR) was 4.2%. Moreover, male, history of smoking, and comorbidities might influence the prognosis. Most clinical symptoms such as fever, high fever, cough, sputum production, fatigue, shortness of breath, dyspnoea, and abdominal pain were linked to the severity of disease. Some specific laboratory indicators implied the deterioration of disease, such as leucocytosis, lymphopenia, platelet, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, creatinine, creatine kinase (CK), lactic dehydrogenase (LDH), C-reactive protein, procalcitonin (PCT), and D-dimer. Besides, the risk of bilateral pneumonia, consolidation, pleural effusion, and enlarged mediastinal nodes was higher in severe cases.
Most COVID-19 patients have fever and cough with lymphopenia and increased inflammatory indices, and the main CT feature is GGO involved bilateral lung. Patients with comorbidities and worse clinical symptoms, laboratory characteristics, and CT findings tend to have poor disease progression.
2019 年冠状病毒病（COVID-19）是一种新兴的全球公共卫生关注的大流行病。我们旨在总结大流行早期 COVID-19 患者的特征，并探讨疾病进展的危险因素。
我们进行了系统评价和荟萃分析，在 2020 年 1 月 1 日至 3 月 18 日期间，在三个数据库中搜索了发表的研究。我们使用随机效应模型计算了严重病例和非严重病例之间汇总估计患病率和优势比的 95％置信区间。
纳入了 90 项涉及 16526 例 COVID-19 患者的研究。高血压（19.1％）和糖尿病（9.5％）是最常见的合并症。最常见的临床症状是发烧（78.4％），咳嗽（58.5％）和疲劳（26.4％）。血清铁蛋白升高（74.2％），C 反应蛋白升高（73.3％）和红细胞沉降率升高（72.2％）是最常报告的实验室异常。大多数患者有双侧肺部受累（82.2％），表现为外周（66.9％）和胸膜下（62.1％）分布，多灶性受累（73.1％）。最常见的 CT 特征是血管扩大（64.3％），磨玻璃影（GGO）（60.7％）和增厚的小叶间隔（55.1％）。呼吸衰竭是最常见的并发症（30.7％），总体病死率（CFR）为 4.2％。此外，男性，吸烟史和合并症可能影响预后。大多数临床症状，如发烧，高热，咳嗽，咳痰，疲劳，呼吸急促，呼吸困难和腹痛，与疾病的严重程度有关。一些特定的实验室指标暗示疾病恶化，例如白细胞增多，淋巴细胞减少，血小板，丙氨酸氨基转移酶（ALT），天冬氨酸氨基转移酶（AST），白蛋白，肌酐，肌酸激酶（CK），乳酸脱氢酶（LDH），C 反应蛋白，降钙素原（PCT）和 D-二聚体。此外，在严重病例中，双侧肺炎，实变，胸腔积液和纵隔淋巴结肿大的风险更高。
大多数 COVID-19 患者有发烧和咳嗽，伴有淋巴细胞减少和炎症指标升高，主要 CT 特征是累及双侧肺部的 GGO。患有合并症和更差的临床症状，实验室特征和 CT 发现的患者病情进展不良的风险更高。
