key: cord-0867548-20ky3t6y
authors: Sun, Pengfei; Qie, Shuyan; Liu, Zongjian; Ren, Jizhen; Li, Kun; Xi, Jianing
title: Clinical characteristics of hospitalized patients with SARS‐CoV‐2 infection: A single arm meta‐analysis
date: 2020-03-11
journal: J Med Virol
DOI: 10.1002/jmv.25735
sha: 141130afe8cf359f90c9f83d73a4c17aff9ee0e8
doc_id: 867548
cord_uid: 20ky3t6y

OBJECTIVE: We aim to summarize reliable evidence of evidence‐based medicine for the treatment and prevention of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) by analyzing all the published studies on the clinical characteristics of patients with SARS‐CoV‐2. METHODS: PubMed, Cochrane Library, Embase, and other databases were searched. Several studies on the clinical characteristics of SARS‐CoV‐2 infection were collected for meta‐analysis. RESULTS: Ten studies were included in Meta‐analysis, including a total number of 50466 patients with SARS‐CoV‐2 infection. Meta‐analysis shows that, among these patients, the incidence of fever was 0.891 (95% CI: 0.818, 0.945), the incidence of cough was 0.722 (95% CI: 0.657, 0.782), and the incidence of muscle soreness or fatigue was 0.425 (95% CI: 0.213, 0.652). The incidence of acute respiratory distress syndrome (ARDS) was 0.148 (95% CI: 0.046, 0.296), the incidence of abnormal chest computer tomography (CT) was 0.966 (95% CI: 0.921, 0.993), the percentage of severe cases in all infected cases was 0.181 (95% CI: 0.127, 0.243), and the case fatality rate of patients with SARS‐CoV‐2 infection was 0.043 (95% CI: 0.027, 0.061). CONCLUSION: Fever and cough are the most common symptoms in patients with SARS‐CoV‐2 infection, and most of these patients have abnormal chest CT examination. Several people have muscle soreness or fatigue as well as ARDS. Diarrhea, hemoptysis, headache, sore throat, shock, and other symptoms are rare. The case fatality rate of patients with SARS‐CoV‐2 infection is lower than that of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). This meta‐analysis also has limitations, so the conclusions of this Meta‐analysis still need to be verified by more relevant studies with more careful design, more rigorous execution, and larger sample size.

Since December 2019, the epidemic of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infectious pneumonia in Wu- han, China. The Chinese government and researchers have taken rapid measures to control the epidemic. 1 On January 30 2020, WHO declared that the epidemic of SARS-CoV-2 was a public health emergency of international concern (PHEIC). At present, the number of patients with SARS-CoV-2 infection is still rising, and its harm to human beings has exceeded the outbreak of severe acute respiratory syndrome (SARS) in China, 2002. 2 The clinical characteristics and the case fatality rate after SARS-CoV-2 infection have always been concerned by people, and it is also the focus of medical workers' research at present. However, due to the different design of different clinical studies and insufficient sample size, the conclusions of the published studies were different. To acquire more accurate conclusions on the clinical characteristics and mortality of patients with SARS-CoV-2 infection, we searched the relevant literatures and carried out single-arm metaanalysis. 3 Our findings provide important guidance for current clinical work on the prevention and treatment of SARS-CoV-2 infection.

Three popular medical databases including PubMed, Cochrane Library, and Embase databases were searched for related literature, using the following keywords: "2019-nCoV," "Coronavirus," "COVID-19,"

"SARS-CoV-2," and "Wuhan Coronavirus." Articles reviewed were dated up to February 24, 2020. In this meta-analysis, there was no language restriction. Only available data from published articles were collected. Data from unpublished papers were not included. detection, patients in critical condition (severe cases are those who need to be sent to the intensive care unit (ICU) for treatment), as well as death due to SARS-CoV-2 infection.

Articles were published repeatedly; studies did not include the research indicators needed for meta-analysis; research data were missing.

First of all, we screened the literature according to the literature abstract, excluding the articles that obviously do not meet the inclusive criteria, and then read the full article for rescreening. If any disagreement on the choice of the literature exists, a third evaluator will join to make the decision. All included literature were evaluated using the Newcastle-Ottawa Scale (NOS). 4 The highest quality of the literature was 9 stars and the lowest 0 stars.

The statistical software Stata version 12.0 was used to carry out the single-arm meta-analysis. In order to reduce the influence of heterogeneity between the included studies on final conclusion, we used the random effects model for meta-analysis. Original data included in the literature were first transformed by double arcsine method to make them conform to the normal distribution and then analyzed in Stata. The initial conclusion obtained by meta-analysis was then restored using formula (P = (sin(tp/2)) 2 ) to reach final conclusion. To objectively evaluate the publication bias of the included literature, the Egger test with P < .05 as the existence of publication bias was performed, the values larger than which were considered as no publication bias.

A total of 284 articles were retrieved, among which 39 papers were removed due to repeated retrieval, 212 papers were removed after reading abstracts, and 23 were eliminated after reading the full text.

At the end, a total of 10 articles 5-14 were included in this metaanalysis, including data from 50 466 patients. The specific operation flow is shown in Figure 1 . The characteristics of the literature are shown in Table 1 .

Through Meta-analysis, we found that among all the clinical char- 

The results of the Egger test are shown in Table 3 . There was a publication bias in the meta-analysis of the ARDS group (P = .008).

SARS-CoV-2 is one type of coronaviruses that belong to the β-coronavirus cluster. It causes the third kind of zoonotic coronavirus

Results of meta-analysis Adjusted results 19 it was found that the sequence homology between SARS-CoV-2 and SARS-CoV was 79.5%. The homology between SARS-CoV-2 and bat coronavirus at the genetic level was 96%. Therefore, very likely it can be confirmed that SARS-CoV-2 comes from bats.

According to the results of meta-analysis, we find that the incidence of fever was 89.1%, the incidence of cough was 72.2%, and the incidence of muscle soreness or fatigue was 42.5%. The incidence of ARDS was 14.8%, the incidence of abnormal CT was 96.6%, the percentage of severe cases in all infected cases was 18.1%, and the case fatality rate of patients with SARS-CoV-2 infection was 4.3%.

Weijie Guan et al. 8 Therefore, based on the above-mentioned limitations, the conclusions of this meta-analysis still need to be verified by more relevant studies with more careful design, more rigorous execution, and larger sample size.

We would like to acknowledge TopEdit LLC for the linguistic editing and proofreading during the preparation of this manuscript.

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The authors declare that there are no conflict of interests.

JX and PS developed the idea for and designed the study and had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. PS and SQ contributed to the writing of the report. JX contributed to the critical revision of the report. SQ, ZL, JR, and KL contributed to the statistical analysis. All authors contributed to data acquisition, data analysis, or data interpretation, and reviewed and approved the final version.

http://orcid.org/0000-0002-8405-2355