| Objective To systematically analyse the clinical features and risk factors of coronavirus disease 2019(COVID-19)that can be used as a reference for clinical treatment and epidemic prevention and control.Methods An electronic search in Pub Med,Scopus,Web of Science,EMbase,CNKI,Wan Fang Data and VIP databases to identify studies describing COVID-19 patients from 1 January 2020 to 31 March 2020.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then,the meta-analysis was performed by using Stata12.0software.Results A total of 104 studies involving 12,477 COVID-19 patients were included.Meta-analysis showed that a higher proportion of infected patients were male(53.3%),and 61.2% of severe patients were male.The two major symptoms observed were fever(78.0%)and cough(56.8%).Other common symptoms included fatigue(27.9%),expectoration(23.6%),anorexia(23.2%),dyspnea(20.7%),chest distress or shortness of breath(18.4%),and myodynia(17.1%).Minor symptoms included sore throat(10.8%),headache(9.0%),nausea and vomiting(7.9%)and diarrhea(5.9%).About 4.9% of the patients were asymptomatic.Most patients showed normal leukocyte counts(70.5%),elevated levels of C-reactive protein(66.2%)and erythrocyte sedimentation rate(56.0%)and lymphopenia(49.9%).Other findings included leucopenia(25.9%),elevated levels of procalcitonin(19.2%),and d-dimer(18.5%),and increased leukocyte counts(7.0%).Lung lesions were mostly bilateral(76.9%)or multilobe(76.5%)involvement,and a few patients showed single-lung(14.1%)or single-lobe(16.9%)involvement.Cord-like,patchy,spider web sign were common lesion shapes in COVID-19 patients,while nodular(18.3%)was rare.The density changes of the lesions were ground-glass opacities(65.9%),air bronchogram sign(45.2%),crazy-paving pattern(34.5%)and consolidation(22.5%).Common concomitant signs were pleural thickening(30.9%),while pleural effusion(5.6%)and lymphadenopathy(5.9%)was rare.Patients with severe disease showed a higher incidence rate of fever(86.9%),cough(65.0%),fatigue(33.8%),expectoration(33.9%),dyspnea(43.3%),chest tightness(32.0%),elevated levels of C-reactive protein(78.0%)and d-dimer(70.0%),lymphopenia(67.6%)and elevated procalcitonin(34.6%).The two major symptoms of children with COVID-19 were fever(51.2%)and cough(43.8%).The proportion of asymptomatic infection in children was 31.4%.The incidence rate of all symptoms and abnormal hematological indicators were lower in children.The average age was higher in severe COVID-19 patients(WMD=10.34,95%CI48.8-57.9).Patients with severe disease showed lower lymphocyte count and lower platelet count,but higher lactate dehydrogenase,alanine aminotransferase,aspartate aminotransferase,creatinine,cardiac troponin I,white blood cell count,procalcitonin,C-reactive protein,interleukin-6,d-dimer and plasma fibrinogen,and longer prothrombin time value.59.8% of the patients had one or more underlying diseases,and the two major underlying diseases were hypertension(33.8%)and diabetes(21.4%).Hypertension(RR=1.43),diabetes(RR=1.53),cardiovascular disease(RR=1.57),respiratory diseas(RR=1.63),malignant tumors(RR=1.37),chronic kidney disease(RR=1.52)and cerebrovascular disease(RR=1.72)all increased the risk of terminal events in patients with COVID-19.Conclusion(1)The most commonly experienced symptoms of COVID-19 patients were fever and cough.Most patients showed normal leukocyte counts,lymphopenia,elevated levels of C-reactive protein and erythrocyte sedimentation rate.(2)The lung lesions of patients with COVID-19 were mostly bilateral lungs or multilobar involved.The common focal signs were ground-glass opacities,cord-like,patchy,spider web sign and air bronchogram.(3)Severe patients had a higher incidence of underlying diseases,more severe damage to immune function and organ function,higher inflammatory markers,and more common coagulation dysfunction.(4)Older age,underlying disease were the risk factors for progression in COVID-19 patients. |
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