Clinical, laboratory and radiological characteristics and outcomes of novel coronavirus

• Published in: PloS one Vol. 15; no. 9; p. e0239235
• Main Authors: Borges do Nascimento, Israel Júnior, von Groote, Thilo Caspar, O'Mathúna, Dónal P, Abdulazeem, Hebatullah Mohamed, Henderson, Catherine, Jayarajah, Umesh, Weerasekara, Ishanka, Poklepovic Pericic, Tina, Klapproth, Henning Edgar Gerald, Puljak, Livia, Cacic, Nensi, Zakarija-Grkovic, Irena, Guimarães, Silvana Mangeon Meirelles, Atallah, Alvaro Nagib, Bragazzi, Nicola Luigi, Marcolino, Milena Soriano, Marusic, Ana, Jeroncic, Ana, Farag, Ehab
• Format: Journal Article
• Language: English
• Published: Public Library of Science 17.09.2020
• Subjects: COVID-19; Development and progression; Diagnosis; Laboratory diagnosis; Methods; Radioscopic diagnosis; Brazil
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0239235

New evidence on the COVID-19 pandemic is being published daily. Ongoing high-quality assessment of this literature is therefore needed to enable clinical practice to be evidence-based. This review builds on a previous scoping review and aimed to identify associations between disease severity and various clinical, laboratory and radiological characteristics. We searched MEDLINE, CENTRAL, EMBASE, Scopus and LILACS for studies published between January 1, 2019 and March 22, 2020. Clinical studies including [greater than or equal to]10 patients with confirmed COVID-19 of any study design were eligible. Two investigators independently extracted data and assessed risk of bias. A quality effects model was used for the meta-analyses. Subgroup analysis and meta-regression identified sources of heterogeneity. For hospitalized patients, studies were ordered by overall disease severity of each population and this order was used as the modifier variable in meta-regression. Overall, 86 studies (n = 91,621) contributed data to the meta-analyses. Severe disease was strongly associated with fever, cough, dyspnea, pneumonia, any computed tomography findings, any ground glass opacity, lymphocytopenia, elevated C-reactive protein, elevated alanine aminotransferase, elevated aspartate aminotransferase, older age and male sex. These variables typically increased in prevalence by 30-73% from mild/early disease through to moderate/severe disease. Among hospitalized patients, 30-78% of heterogeneity was explained by severity of disease. Elevated white blood cell count was strongly associated with more severe disease among moderate/severe hospitalized patients. Elevated lymphocytes, low platelets, interleukin-6, erythrocyte sedimentation rate and D-dimers showed potential associations, while fatigue, gastrointestinal symptoms, consolidation and septal thickening showed non-linear association patterns. Headache and sore throat were associated with the presence of disease, but not with more severe disease. In COVID-19, more severe disease is strongly associated with several clinical, laboratory and radiological characteristics. Symptoms and other variables in early/mild disease appear non-specific and highly heterogeneous.