Correlations of Clinical and Laboratory Characteristics of COVID-19: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy and Data Extraction
2.2. Statistical Analysis
3. Results
3.1. Summary of Previously Published Meta-Analyses
3.2. Study Selection and General Characteristics
3.3. Clinical Characteristics
3.4. Laboratory Findings and Chest Imaging
3.5. Treatments
3.6. Correlation of Clinical Characteristics with Demographics and Laboratory Findings
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Authors | Included Studies, n | Sample Size | Study Period | Findings | Comment |
---|---|---|---|---|---|
Rodriguez-Morales AJ et al. (2020) [13] | 19 | 656 | Until 23 February 2020 | For 656 patients, fever (88.7%, 95% CI 84.5–92.9%), cough (57.6%, 95% CI 40.8–74.4%) and dyspnea (45.6%, 95%CI 10.9–80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95% CI 10.0–30.6%) required ICU, 32.8% presented with ARDS (95% CI 13.7–51.8), 6.2% (95% CI 3.1–9.3) with shock. | Clinical characteristics, laboratory findings, imaging findings and fatal outcome of patients with COVID-19 are summarized in this article—there is no correlations between clinical characteristics, laboratory findings. |
Li et al. (2020) [14] | 10 | 1994 | December 2019 to February 2020 | The main clinical symptoms of COVID-19 patients were fever (88.5%), cough (68.6%), myalgia or fatigue (35.8%), expectoration (28.2%), and dyspnea (21.9%). The results of the laboratory showed that the lymphocytopenia (64.5%), increase in CRP (44.3%), increase in LDH (28.3%), and leukocytopenia (29.4%) were more common. | Clinical characteristics, laboratory findings and fatal outcome or discharge rate of patients with COVID-19 are summarized in this article—there is no correlations between clinical characteristics and laboratory findings |
Zhang et al. (2020) [15] | 7 | 4663 | Not mentioned (the paper received 13 April 2020) | Patients with elevated CRP levels, lymphopenia, or LDH require proper management and, if necessary, transfer to the ICU. | Laboratory findings are summarized in this article—not mentioning clinical characteristics. |
Zeng et al. (2020) [16] | 16 | 3962 | Until 20 March 2020 | Patients with COVID-19 in the non-severe group had lower levels for CRP, PCT, IL-6, ESR, SAA and serum ferritin compared with those in the severe group. | The paper highlights the association of inflammatory markers with the severity of COVID-19—not mentioning clinical characteristics. |
Wang et al. (2020) [17] | 49 | 1667 | Until 31 March 2020 | The main symptoms of children were fever [48%, 95% CI: 39%, 56%] and cough (39%, 95% CI: 30%, 48%). The lymphocyte count was below normal level in only 15% (95% CI: 8%, 22%) of children which is different from adult patients. | Clinical characteristics and laboratory findings in children were summarized (not for adults)—there is no correlations between clinical characteristics and laboratory findings |
Lovato et al. (2020) [18] | 5 | 1556 | Until 24 February 2020 | Common symptoms were fever (85.6%), cough (68.7%), and fatigue (39.4%). Lymphopenia (77.2%) and leucopenia (30.1%) were common. Critical cases with complications were 9%, ICU admission was required in 7.3%, invasive ventilation in 3.4%, and mortality was 2.4%. | Clinical characteristics, laboratory findings and fatal outcome of patients with COVID-19 are summarized in this article—there is no correlations between clinical characteristics and laboratory findings. |
Fu et al. (2020) [19] | 43 | 3600 | 24 January 2020 to 28 February 2020 | Among COVID-19 patients, fever (83.3% [95% CI 78.4–87.7]), cough (60.3% [54.2–66.3]), and fatigue (38.0% [29.8–46.5]) were the most common clinical symptoms. The most common laboratory abnormalities were elevated CRP (68.6% [58.2–78.2]), decreased lymphocyte count (57.4% [44.8–69.5]) and increased LDH (51.6% [31.4–71.6]). The overall estimated proportion of severe cases and CFR was 25.6% (17.4–34.9) and 3.6% (1.1–7.2), respectively. | The paper summarized the symptoms and laboratory findings associated with CFR—there is no correlations between clinical characteristics and laboratory findings. |
Li et al. 2020 [20] | 12 | 2445 | 1 January 2020 to 14 April 2020 | Significant differences between the ICU and non-ICU groups for fever, dyspnea, decreased lymphocyte and platelet counts, and increased leukocyte count, CRP, PCT, LDH, aspartate, aminotransferase, alanine aminotransferase, CK, and creatinine levels (p < 0.05). | Investigation of clinical characteristics and outcomes of severe cases of COVID-19—there is no correlations between clinical characteristics and laboratory findings. |
Variable | Number of Studies | Mean/Prevalence (%) | 95% CI | Number of Patients | p Value | |
---|---|---|---|---|---|---|
Clinical Symptoms | ||||||
Fever | 30 | 77 | 0.69–0.85 | 2628 | 98.2 | <0.0001 |
Cough | 32 | 60 | 0.48–0.71 | 2110 | 98.6 | 0 |
Fatigue/Myalgia | 24 | 31 | 0.23–0.40 | 1005 | 98.1 | <0.0001 |
Dyspnea | 19 | 25 | 0.20–0.31 | 533 | 97.8 | <0.0001 |
Sputum production | 16 | 23 | 0.15–0.32 | 624 | 97.9 | <0.0001 |
Chest tightness | 14 | 17 | 0.11–0.23 | 175 | 95.8 | <0.0001 |
Pharyngalgia | 16 | 13 | 0.09–0.16 | 285 | 78.4 | <0.0001 |
Chill | 4 | 10 | 0.04–0.16 | 85 | 96.7 | <0.0001 |
Headache | 15 | 10 | 0.06–0.14 | 276 | 91.5 | <0.0001 |
Diarrhea | 22 | 6 | 0.05–0.08 | 158 | 56.0 | 0.0008 |
Rhinorrhea | 12 | 6 | 0.04–0.08 | 120 | 75.4 | <0.0001 |
Dizziness | 4 | 6 | 0.02–0.10 | 19 | 50.5 | 0.1086 |
Nausea/Vomiting | 15 | 5 | 0.03–0.06 | 154 | 83.9 | <0.0001 |
Hemoptysis | 4 | 3 | 0.004–0.05 | 22 | 59.6 | 0.0593 |
Laboratory findings | ||||||
Increased WBC | 12 | 12 | 0.08–0.16 | 192 | 90.3 | <0.0001 |
Decreased WBC | 12 | 25 | 0.18–0.32 | 536 | 91.4 | <0.0001 |
Decreased lymphocyte | 9 | 63 | 0.47–0.78 | 486 | 96.6 | <0.0001 |
Increased neutrophil | 5 | 31 | 0.08–0.55 | 132 | 98.1 | <0.0001 |
Decreased neutrophil | 4 | 9 | 0.02–0.17 | 46 | 88.7 | <0.0001 |
Increased platelet | 3 | 6 | 0.02–0.11 | 22 | 56.5 | 0.1003 |
Decreased platelet | 6 | 16 | 0.03–0.29 | 370 | 96.9 | <0.0001 |
Increased ALT | 5 | 21 | 0.14–0.27 | 229 | 78.4 | 0.001 |
Increased AST | 5 | 29 | 0.17–0.41 | 277 | 92.9 | <0.0001 |
Increased D-dimer | 5 | 48 | 0.15–0.80 | 418 | 99.4 | <0.0001 |
Increased creatinine | 4 | 11 | 0.03–0.20 | 69 | 95.2 | <0.0001 |
Increased CRP | 9 | 66 | 0.51–0.81 | 573 | 98.0 | <0.0001 |
Increased creatine kinase | 5 | 32 | 0.10–0.54 | 186 | 98.8 | <0.0001 |
Increased total bilirubin | 4 | 14 | 0.06–0.22 | 120 | 93.3 | <0.0001 |
Increased procalcitonin | 6 | 36 | 0.16–0.57 | 214 | 98.7 | <0.0001 |
Decreased LDH | 5 | 57 | 0.32–0.83 | 477 | 98.6 | <0.0001 |
Decreased albumin | 3 | 61 | 0.00–1.00 | 162 | 99.9 | <0.0001 |
Increased glucose | 2 | 45 | 0.34–0.57 | 110 | 70.9 | 0.0636 |
Chest Imaging | ||||||
Bilateral infiltration | 16 | 76 | 0.67–0.85 | 2157 | 98.7 | <0.0001 |
Unilateral infiltration | 5 | 20 | 0.12–0.28 | 443 | 80.3 | 0.0004 |
Variable | Number of Studies | Mean/Prevalence (%) | 95% CI | Number of Patients | p Value | |
---|---|---|---|---|---|---|
Antiviral agent | 10 | 0.79 | 0.64–0.95 | 653 | 99.5 | 0 |
Antibiotic agent | 9 | 0.78 | 0.62–0.94 | 1072 | 99.3 | <0.0001 |
Antifungal agent | 2 | 0.01 | 0.01–0.04 | 31 | 94.1 | <0.0001 |
Corticosteroid | 10 | 0.25 | 0.16–0.34 | 407 | 95.4 | <0.0001 |
Gamma globulin | 6 | 0.25 | 0.16–0.34 | 267 | 91.5 | <0.0001 |
Oxygen inhalation/nasal cannula | 8 | 0.75 | 0.53–0.97 | 930 | 99.4 | <0.0001 |
Non-invasive ventilation | 8 | 0.23 | 0.16–0.30 | 211 | 96.4 | <0.0001 |
RRT | 2 | 0.08 | 0.00–0.24 | 18 | 89.8 | 0.0017 |
ECMO | 4 | 0.03 | 0.00–0.06 | 17 | 72.0 | 0.0133 |
Age | Fever | Cough | Fatigue and Myalgia | Dyspnea | Sputum Production | Chest Tightness | Pharyngalgia | Chill | Headache | Lung Abnormality | WBC | Neutrophil | Lymphocyte | Platelet | D-Dimer | CRP | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Age | . | −0.267 | 0.199 | 0.112 | 0.764 ** | −0.461 | 0.503 | −0.241 | −0.963 | −0.518 | 0.413 | 0.596 * | 0.744 ** | −0.651 ** | 0.006 | 0.796 * | 0.165 |
0.179 | 0.320 | 0.618 | 0.000 | 0.097 | 0.080 | 0.407 | 0.173 | 0.070 | 0.143 | 0.015 | 0.009 | 0.005 | 0.986 | 0.010 | 0.628 | ||
Fever | −0.267 | . | −0.427 * | −0.154 | −0.261 | 0.071 | 0.331 | 0.245 | 0.695 | 0.148 | −0.399 | −0.121 | −0.406 | 0.419 | −0.120 | −0.036 | −0.508 |
0.179 | 0.021 | 0.483 | 0.296 | 0.801 | 0.248 | 0.361 | 0.305 | 0.614 | 0.141 | 0.643 | 0.191 | 0.094 | 0.711 | 0.915 | 0.092 | ||
Cough | 0.199 | −0.427* | . | 0.373 | 0.291 | 0.674 ** | −0.309 | 0.155 | 0.689 | 0.342 | 0.023 | −0.247 | 0.106 | −0.191 | −0.155 | −0.218 | 0.389 |
0.320 | 0.021 | 0.073 | 0.242 | 0.004 | 0.283 | 0.568 | 0.311 | 0.213 | 0.935 | 0.324 | 0.732 | 0.447 | 0.612 | 0.544 | 0.189 | ||
Fatigueand myalgia | 0.112 | −0.154 | 0.373 | . | 0.336 | 0.557 * | 0.358 | 0.327 | 0.821 | 0.476 | 0.298 | −0.402 | −0.296 | −0.272 | −0.457 | 0.065 | 0.109 |
0.618 | 0.483 | 0.073 | 0.220 | 0.031 | 0.253 | 0.276 | 0.179 | 0.073 | 0.300 | 0.137 | 0.377 | 0.327 | 0.158 | 0.858 | 0.750 | ||
Dyspnea | 0.764 ** | −0.261 | 0.291 | 0.336 | . | 0.413 | 0.135 | −0.272 | 0.865 | 0.016 | −0.007 | 0.728 ** | 0.797 * | −0.700 * | 0.301 | 0.649 | 0.164 |
0.000 | 0.296 | 0.242 | 0.220 | 0.270 | 0.729 | 0.392 | 0.335 | 0.964 | 0.987 | 0.007 | 0.010 | 0.011 | 0.431 | 0.163 | 0.698 | ||
Sputum production | −0.461 | 0.071 | 0.674 ** | 0.557 * | 0.413 | . | 0.707 | 0.268 | 0.806 | 0.759 ** | 0.303 | −0.539 | −0.261 | −0.234 | −0.560 | −0.502 | 0.193 |
0.097 | 0.801 | 0.004 | 0.031 | 0.270 | 0.181 | 0.521 | 0.194 | 0.007 | 0.365 | 0.087 | 0.533 | 0.489 | 0.149 | 0.310 | 0.678 | ||
Chest tightness | 0.503 | 0.331 | −0.309 | 0.358 | 0.135 | 0.707 | . | 0.295 | 1.000 ** | 0.236 | 0.701 | 0.002 | 0.606 | −0.208 | −0.414 | 0.357 | −0.170 |
0.080 | 0.248 | 0.283 | 0.253 | 0.729 | 0.181 | 0.408 | . | 0.764 | 0.299 | 0.997 | 0.202 | 0.591 | 0.586 | 0.432 | 0.661 | ||
Pharyngalgia | −0.241 | 0.245 | 0.155 | 0.327 | −0.272 | 0.268 | 0.295 | . | 0.981 | 0.046 | −0.104 | −0.441 | −0.501 | 0.395 | −0.260 | −0.598 | −0.079 |
0.407 | 0.361 | 0.568 | 0.276 | 0.392 | 0.521 | 0.408 | 0.126 | 0.931 | 0.824 | 0.175 | 0.169 | 0.229 | 0.574 | 0.210 | 0.840 | ||
Chill | −0.963 | 0.695 | 0.689 | 0.821 | 0.865 | 0.806 | 1.000 ** | 0.981 | . | 0.900 | 1.000 ** | 0.419 | 1.000 ** | 1.000 ** | 1.000 ** | −1.000 ** | 1.000 ** |
0.173 | 0.305 | 0.311 | 0.179 | 0.335 | 0.194 | . | 0.126 | 0.287 | . | 0.725 | . | . | . | . | . | ||
Headache | −0.518 | 0.148 | 0.342 | 0.476 | 0.016 | 0.759 ** | 0.236 | 0.046 | 0.900 | . | 0.007 | −0.522 | −0.588 | 0.440 | −0.160 | −0.755 | −0.669 |
0.070 | 0.614 | 0.213 | 0.073 | 0.964 | 0.007 | 0.764 | 0.931 | 0.287 | 0.985 | 0.184 | 0.220 | 0.275 | 0.704 | 0.140 | 0.331 | ||
Lung abnormality | 0.413 | −0.399 | 0.023 | 0.298 | −0.007 | 0.303 | 0.701 | −0.104 | 1.000 ** | 0.007 | . | 0.164 | −0.214 | 0.082 | −0.138 | −0.445 | 0.725 |
0.143 | 0.141 | 0.935 | 0.300 | 0.987 | 0.365 | 0.299 | 0.824 | . | 0.985 | 0.630 | 0.611 | 0.811 | 0.705 | 0.270 | 0.065 | ||
WBC | 0.596 * | −0.121 | −0.247 | −0.402 | 0.728 ** | −0.539 | 0.002 | −0.441 | 0.419 | −0.522 | 0.164 | . | 0.696 ** | −0.098 | 0.668 ** | 0.344 | 0.597* |
0.015 | 0.643 | 0.324 | 0.137 | 0.007 | 0.087 | 0.997 | 0.175 | 0.725 | 0.184 | 0.630 | 0.006 | 0.700 | 0.009 | 0.300 | 0.024 | ||
Neutrophil | 0.744 ** | −0.406 | 0.106 | −0.296 | 0.797* | −0.261 | 0.606 | −0.501 | 1.000 ** | −0.588 | −0.214 | 0.696 ** | . | −0.639 * | 0.024 | 0.686 | 0.141 |
0.009 | 0.191 | 0.732 | 0.377 | 0.010 | 0.533 | 0.202 | 0.169 | . | 0.220 | 0.611 | 0.006 | 0.019 | 0.945 | 0.061 | 0.679 | ||
Lymphocyte | −0.651 ** | 0.419 | −0.191 | −0.272 | −0.700 * | −0.234 | −0.208 | 0.395 | 1.000 ** | 0.440 | 0.082 | −0.098 | −0.639 * | . | 0.469 | −0.546 | −0.039 |
0.005 | 0.094 | 0.447 | 0.327 | 0.011 | 0.489 | 0.591 | 0.229 | . | 0.275 | 0.811 | 0.700 | 0.019 | 0.106 | 0.103 | 0.899 | ||
Platelet | 0.006 | −0.120 | −0.155 | −0.457 | 0.301 | −0.560 | −0.414 | −0.260 | 1.000 ** | −0.160 | −0.138 | 0.668 ** | 0.024 | 0.469 | . | −0.434 | 0.703 * |
0.986 | 0.711 | 0.612 | 0.158 | 0.431 | 0.149 | 0.586 | 0.574 | . | 0.704 | 0.705 | 0.009 | 0.945 | 0.106 | 0.283 | 0.035 | ||
D-dimer | 0.796 * | −0.036 | −0.218 | 0.065 | 0.649 | −0.502 | 0.357 | −0.598 | −1.000 ** | −0.755 | −0.445 | 0.344 | 0.686 | −0.546 | −0.434 | . | −0.259 |
0.010 | 0.915 | 0.544 | 0.858 | 0.163 | 0.310 | 0.432 | 0.210 | . | 0.140 | 0.270 | 0.300 | 0.061 | 0.103 | 0.283 | 0.501 | ||
CRP | 0.165 | −0.508 | 0.389 | 0.109 | 0.164 | 0.193 | −0.170 | −0.079 | 1.000 ** | −0.669 | 0.725 | 0.597 * | 0.141 | −0.039 | 0.703 * | −0.259 | . |
0.628 | 0.092 | 0.189 | 0.750 | 0.698 | 0.678 | 0.661 | 0.840 | . | 0.331 | 0.065 | 0.024 | 0.679 | 0.899 | 0.035 | 0.501 |
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Ghayda, R.A.; Lee, J.; Lee, J.Y.; Kim, D.K.; Lee, K.H.; Hong, S.H.; Han, Y.J.; Kim, J.S.; Yang, J.W.; Kronbichler, A.; et al. Correlations of Clinical and Laboratory Characteristics of COVID-19: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 5026. https://doi.org/10.3390/ijerph17145026
Ghayda RA, Lee J, Lee JY, Kim DK, Lee KH, Hong SH, Han YJ, Kim JS, Yang JW, Kronbichler A, et al. Correlations of Clinical and Laboratory Characteristics of COVID-19: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2020; 17(14):5026. https://doi.org/10.3390/ijerph17145026
Chicago/Turabian StyleGhayda, Ramy Abou, Jinhee Lee, Jun Young Lee, Da Kyung Kim, Keum Hwa Lee, Sung Hwi Hong, Young Joo Han, Jae Seok Kim, Jae Won Yang, Andreas Kronbichler, and et al. 2020. "Correlations of Clinical and Laboratory Characteristics of COVID-19: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 17, no. 14: 5026. https://doi.org/10.3390/ijerph17145026