key: cord-0715685-ukhgs6z1 authors: Goel, Sunny; Jain, Tarun; Hooda, Amit; Malhotra, Rohit; Johal, Gurpreet; Masoomi, Reza; Kamran, Haroon; Krishnamoorthy, Parasuram Melarcode; Senguttuvan, Nagendra Boopathy; Sharma, Abhishek; Gidwani, Umesh title: Clinical Characteristics and In-Hospital Mortality for COVID-19 Across The Globe date: 2020-07-18 journal: Cardiol Ther DOI: 10.1007/s40119-020-00189-0 sha: 74ac30de42df6d816550284fa197a62cef702b48 doc_id: 715685 cord_uid: ukhgs6z1 INTRODUCTION: Numerous case series have reported on the baseline characteristics and in-hospital mortality of patients with COVID-19, however, these studies included patients localized in a specific geographic region. The purpose of our study was to identify differences in the clinical characteristics and the in-hospital mortality of patients with a laboratory-confirmed diagnosis of COVID-19 internationally. METHODS: A comprehensive search of all published literature on adult patients with laboratory-confirmed diagnosis of COVID-19 that reported on the clinical characteristics and in-hospital mortality was performed. Groups were compared using a Chi-square test with Yates correction of continuity. A two-tailed p value of less than 0.05 was considered as statistically significant. RESULTS: After screening 516 studies across the globe, 43 studies from 12 countries were included in our final analysis. Patients with COVID-19 in America and Europe were older compared to their Asian counterparts. Europe had the highest percentage of male patients. American and European patients had a higher incidence of co-morbid conditions (p < 0.05 for all variables). In-hospital mortality was significantly higher in America (22.23%) and Europe (22.9%) compared to Asia (12.65%) (p < 0.0001), but no difference was seen when compared with each other (p = 0.49). CONCLUSIONS: There is a significant variation in the clinical characteristics in patients diagnosed with COVID-19 across the globe. In-hospital mortality is similar between America and Europe, but considerably higher than Asia. Why carry out this study? Numerous case series have reported on the baseline characteristics and in-hospital mortality of patients with COVID-19, however, these studies included patients localized in a specific geographic region. There is a significant variation in the clinical characteristics in patients diagnosed with COVID-19 across the globe. What was learned from the study? We found American and European patients diagnosed with COVID-19 are older and had a higher incidence of comorbid conditions as compared to Asian patients. Coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020 [1] , and has placed an unprecedented burden on the various health care systems across the globe [2] . Numerous case series have reported on the baseline characteristics and inhospital mortality of patients with COVID-19, however, these studies included patients localized in a specific geographic region [3] [4] [5] [6] [7] [8] . The purpose of our study was to identify differences in the clinical characteristics and the in-hospital mortality of patients with a laboratory-confirmed diagnosis of COVID-19 internationally. We performed a comprehensive search of PubMed, MEDLINE, Scopus, and Web of Sciences databases for studies published between January 1, 2020, and May 1, 2020. The following keywords were used for search in different combinations: ''Coronavirus 2019'', ''COVID-19'', ''novel coronavirus'', ''SARSCoV2'', ''clinical characteristics'', ''baseline demographics'', ''mortality'', ''all-cause mortality'', ''in-hospital outcomes'', and ''outcomes''. We included studies that had more than ten adult patients ([ 18 years), and reported clinical characteristics of patients diagnosed with laboratory-confirmed COVID-19, along with all-cause mortality as one of the outcomes. We excluded studies from publicly available databases, which did not report clinical characteristics. In addition, we excluded nationwide in-hospital sample datasets and multicenter registries to avoid an overlap in patient populations. All studies from China were thoroughly evaluated for duplication of patients. If a single center had multiple publications, studies with a smaller sample size and those lacking outcomes of interest were excluded. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. The database used in the study is publicly available and can be found at https://pubmed.ncbi.nlm.nih.gov/ ?term=COVID-19?AND?clinical?characterstic ?AND?Mortality&sort=date&size=100. After screening 516 studies across the globe, 43 studies from 12 countries were included in our final analysis. We categorized these studies into three geographical areas: America [11 studies (10-United States; 1-Brazil)], Asia [24 studies (20-China; 1-India; 1-Iran; 1-Korea; 1-Singapore)], and Europe [8 studies (3-Italy; 2-France; 1-Denmark; 1-Ireland; 1-Spain)]. Of the 43 studies, 11 of them reported data strictly on patients who were in critical condition [4-6, 10, 11, 22, 32, 35, 38, 42, 45] . A Chi-square test with Yates correction of continuity for (Fig. 1) . In-hospital mortality was significantly higher in America and Europe compared to Asia (p \ 0.0001), but no significant difference in in-hospital mortality was seen when compared with each other (p = 0.49), despite most of the reported patients from Europe being critically ill. To the best of our knowledge, this study is the first to systematically evaluate the overall prevalence of comorbid conditions and in-hospital mortality among patients diagnosed with COVID-19 across the globe. When comparing patients based on their geographic location, a significant difference in the clinical characteristics and in-hospital mortality was seen among patients diagnosed with COVID-19. Despite considerable variations in the individual studies due to the sample size, severity of disease (mild illness vs. critical illness) and geographical region, cardiovascular comorbidities such as HTN, DM, and CAD/CVD were the most common comorbidities in patients diagnosed with COVID-19. Apart from cardiovascular diseases, respiratory conditions [lung disease, COPD, or asthma], CKD, and immunosuppression/HIV were also prevalent among COVID-19 patients. Our results should be interpreted with the caveat that most studies did not have complete follow-up data, and the majority of patients were still hospitalized without a definite Fig. 1 Clinical characteristics and in-hospital mortality of COVID-19 patients across the globe outcome (i.e., mortality). Therefore, it is difficult to ascertain an accurate case fatality rate from this study. In addition, patient age was reported as mean in some studies and median in others, and as a result, we cannot determine if patient age was significantly different between the groups. There is a significant variation in the clinical characteristics in patients diagnosed with COVID-19 across the globe. In-hospital mortality is similar between America and Europe, but considerably higher than Asia. Funding. No funding or sponsorship was received for this study or publication of this article. Authorship. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Compliance with Ethics Guidelines. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. The database used in the study is publicly available and can be found at https:// pubmed.ncbi.nlm.nih.gov/?term=COVID-19? AND?clinical?characterstic?AND?Mortality& sort=date&size=100 Data Availability. The datasets during and/ or analyzed during the current study are available from the corresponding author on reasonable request. Open Access. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/bync/4.0/. WHO declares COVID-19 a pandemic Covid-19-navigating the uncharted Clinical characteristics of Covid-19 in New York City Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Clinical characteristics of 225 patients with COVID-19 in a tertiary Hospital near Wuhan Epidemiological and clinical features of 125 Hospitalized Patients with COVID-19 in Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): early report from the United States SARS-CoV-2 in Spanish intensive care units: early experience with 15-day survival in Vitoria Covid-19 in critically ill patients in the Seattle region-case series Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a randomized clinical trial Clinical progression of patients with COVID-19 in Shanghai Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Clinical Characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China: a single-centered, retrospective study Characteristics of emergency department patients with COVID-19 at a single site in northern California: clinical observations and public health implications Clinical features of COVID-19-related liver damage COVID19 coagulopathy in Caucasian patients Prognostic value of NT-proBNP in patients with severe COVID-19 Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: a pilot observational study Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India Comparing rapid scoring systems in mortality prediction of critical ill patients with novel coronavirus disease Clinical course and outcomes of patients with severe acute respiratory syndrome coronavirus 2 infection: a preliminary Report of the First 28 Patients from the Korean Cohort Study on COVID-19 A cross-sectional comparison of epidemiological and clinical features of patients with coronavirus disease (COVID-19) in Wuhan and outside Wuhan. China Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study Epidemiology of Covid-19 in a Long-Term Care Facility in King County. Washington Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: a single center study Initial experiences from patients with COVID-19 on ventilatory support in Denmark Prevalence and characteristics of gastrointestinal symptoms in patients with SARS-CoV-2 Infection in the United States: a multicenter cohort study Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation Clinical impact of renin-angiotensin system inhibitors on in-hospital mortality of patients with hypertension hospitalized for COVID-19 Clinical features and treatment of COVID-19 patients in northeast Chongqing Suppressed T cellmediated immunity in patients with COVID-19: a clinical retrospective study in Wuhan Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan. China Clinical characteristics of patients with 2019 coronavirus disease in a non-Wuhan area of Hubei Province, China: a retrospective study Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study Potential benefits of precise corticosteroids therapy for severe 2019-nCoV pneumonia