key: cord-0869188-7wtsw1cf authors: Vaseghi, G.; Mansourian, M.; Karimi, R.; Heshmat-Ghahdarijani, K.; Baradaran Mahdavi, S.; Pezeshki, A.; Ataei, B.; Zandifar, A.; Shafaat, O.; Haghjoo Javanmard, S. title: Clinical characterization and chest CT findings in laboratory-confirmed COVID-19: a systematic review and meta-analysis date: 2020-03-08 journal: nan DOI: 10.1101/2020.03.05.20031518 sha: 1cdd0a98730a1ac4856c95e313f40f389ade4218 doc_id: 869188 cord_uid: 7wtsw1cf Background: Imagery techniques have been used as essential parts of diagnostic workup for patients suspected for 2019-nCoV infection, Multiple studies have reported the features of chest computed tomography (CT) scans among a number of 2019-nCoV patients. Method: Study Identification was carried out in databases (PubMed, Embase and Cochrane Library) to identify published studies examining the diagnosis, the 2019 novel coronavirus (2019-nCoV). Heterogeneity among reported prevalence was assessed by computing p-values of Cochrane Q-test and I2-statics. The pooled prevalence of treatment failure was carried out with a fixed effects meta-analysis model, generating the pooled 95% confidence interval. A random-effect model was used to pool the results since this model could incorporate the heterogeneity of the studies and therefore proved a more generalized result. Results: According to the combined results of meta-analysis, the total 55% of corona patients were males. The mean age of the patients was 41.31 (34.14, 48.47). Two prevalent clinical symptoms between patients were fever, cough with prevalence of 85%, and 62%, respectively. Either Ground Glass Opacity GGO or consolidation was seen in 86% but 14% had NO GGO or consolidation. The other rare CT symptoms were pericardial effusion, and pleural effusion with 4, 5, 7% prevalence, respectively. The most prevalent event was Either GGO or consolidation in 85% of patients. Conclusion: The most CT-scan abnormality is Either Ground Glass Opacity GGO or consolidation however in few patients none of them might be observed, so trusting in just CT findings will lead to miss some patients. The results based on clinical and CT-scan symptoms are presented in table.1. According to the combined results of meta-analysis, the total 55% of corona patients were males. The mean age of the patients was 41.31 (34.14, 48.47). Two prevalent clinical symptoms between patients were fever, cough with prevalence of 85%, and 62%, respectively. The rare CT-scan symptoms were lymphadenopathy (LAP), pericardial effusion, and pleural effusion with 4, 5, 7% prevalence, respectively. Bilateral involvement of lung was observed in 82% of patients studies with 83 sample size in which GGO without consolidation was more prevalent (72%) than the other one. The funnel plots for the meta-analysis of the prevalence of different symptoms in Corona patients were not shown. The plots were symmetrical on visual inspection, indicating low risk of publication bias in most of status. The Egger's regression tests also demonstrated in Table. 1. For studies with high risk of publication the adjusted trim and fill statistics were presents in table.1 The quality of evidence and confidence for the main outcomes (primary outcomes) of including studies in our review will be evaluated and assessed on the basis of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guideline (16) . The quality of evidence will be adjudicated into 4 levels: "very low", "low", "moderate" or "high" All rights reserved. No reuse allowed without permission. the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is . https://doi.org/10.1101/2020.03.05.20031518 doi: medRxiv preprint judgment. Any discrepancy will be resolved by consensus or consultation with a third review author (RK). All studies had the high score in judgment. According to rapid spread of new corona virus 2019 in the world (reported in 86 countries as of March 5, 2020), it is crucial to stablish robust clinical data to help health care providers control the outbreak (17). Early diagnosis of 2019-nCoV can lead to patient isolation strategies which in turn leads to reduction of viral transition. The epidemiological history may be vague and the sign and symptoms of the disease may resemble other viral infections. The RT-PCR tests of serum or respiratory specimens may be unavailable for all suspected patients as well. There is the possibility of initial false negative results of RT-PCR tests due to lack of replicable nucleic acid or technical errors as well (18). In this context, chest CT images are important elements of clinical workflow of 2019-nCoV, with respect to screening, diagnosis and followup. In this systematic review and meta-analysis, we aimed to find the answer for this question that whether there is any fix pattern of pulmonary involvement in chest CT scans of patients with 2019-nCoV infection according to available evidence. Our pooled data revealed that the most common patterns of CT scan in infected patients were Ground Glass Opacity (GGO), interlobular septal thickening and consolidation (presented in 79%, 66% and 40% of cases respectively) especially in bilateral lower lobes of lung (reported in 38% of patients). Right middle lobe, right upper lobe and left upper lobe are involved less than lower lobes (26%, 15% and 3% respectively). The patterns of lesions are mostly bilateral (82%) and peripheral (56%). Crazy paving pattern, LAP, pericardial and pleural effusion and sub-pleural signs were the other CT scan findings accordingly (6, 19, 20) . However there are positive RT-PCR cases with normal pattern of chest CT scan suggesting not to exclude these patients of 2019-nCoV (21) . All rights reserved. No reuse allowed without permission. the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is . https://doi.org/10.1101/2020.03.05.20031518 doi: medRxiv preprint Above findings are in consistent with recent studies in which the chest CT characteristics of 2019-nCoV pneumonia were identified. Bilateral peripheral ground-glass and consolidative pulmonary opacities were found in CT scans of 21 patients from China. In this study, 15 cases (71%) had the involvement of more than 2 lobes. Also pulmonary nodules, cavitation, pleural effusions, and lymphadenopathy were absent in the cases (5). Another study among 6 patients with confirmed diagnosis of 2019-nCoV in China revealed multifocal or unifocal involvement of ground-glass opacity (GGO) with consolidation and fibrosis as basic pattern. In this study pleural effusion and lymphadenopathy were absent as well. Also the lesions generally progressed in follow-up CT scans obtained between 2 to 6 days after initial images (22) . It is worthwhile to consider the dynamic nature of chest CT findings of 2019-nCoV, i.e., the alteration of finings that may be observed in repeated measures. In a study among 21 nonrespiratory compromised patients with 2019-nCoV, multiple CT images were performed in the process of recovery. The authors classified 4 radiologic stages. In stage 1 (0-4 days after onset of disease), GGO in the lower lobes was the main finding. In stage 2 (5-8 days after the onset) the infection extended and diffuse GGO, crazy-paving pattern and consolidation were observed. In stage 3 (9-13 days after the onset, peak stage), the consolidation was the dominant abnormality and finally in sage 4 (≥14 days after the onset, absorption stage), consolidation was absorbed. There was no crazy-paving pattern but still a remarkable GGO abnormality in this stage. Furthermore, in this study, GGO and peripheral distribution were dominant (more than 50% of patients) in all 4 stages. Also, bilateral multilobe involvement was dominant in stages 2, 3 and 4. Similar to some case reports (23, 24) , it can be concluded that chest CT the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is . https://doi.org/10.1101/2020.03.05.20031518 doi: medRxiv preprint All rights reserved. No reuse allowed without permission. the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is . https://doi.org/10.1101/2020.03.05.20031518 doi: medRxiv preprint All rights reserved. No reuse allowed without permission. the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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