key: cord-1008156-liwqf370
authors: Shi, Li; Wang, Ying; Wang, Yadong; Duan, Guangcai; Yang, Haiyan
title: Dyspnea rather than fever is a risk factor for predicting mortality in patients with COVID-19
date: 2020-05-15
journal: J Infect
DOI: 10.1016/j.jinf.2020.05.013
sha: 3a7f2c601e882b6c50064049663373c2539e37ea
doc_id: 1008156
cord_uid: liwqf370

nan

was positively associated with the progression of COVID-19 such as severe illness and death (OR = 4.16, 95% CI [3.13-5 .53], P < 0.00001) (1) , which suggests that COVID-19 patients with fever may have a lower risk to develop to severe and critical disease outcomes and COVID-19 patients with dyspnea may have a higher risk to develop to severe and critical disease outcomes. However, Fu et al. observed that there was no statistically significant association between fever or shortness of breath and the severity of patients with COVID-19 (2) . To unambiguously identify the risk factors for predicting mortality in patients with COVID-19, we carry out a meta-analysis to evaluate whether fever and dyspnea (not included shortness of breath) were associated with the risk of mortality in COVID-19 patients.

This meta-analysis was carried out based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Li Shi and Ying Wang systematically searched the electronic databases, including Web of Science, Chinese National Knowledge Infrastructure (CNKI) and PubMed. These search engines were utilized to capture available literature by using the following three groups of keywords: "coronavirus 2019, 2019-nCoV, SARS-CoV-2, COVID-19", "outcome, mortality" and "clinical". The last search was conducted on May 4, 2020.

Only articles reporting the number of COVID-19 patients with clinical symptoms of fever or dyspnea in the survival group and non-survival group were identified as eligible articles. All calculations were implemented with Stata 11.2 software. The pooled odds ratio (OR) with the corresponding 95% confidence interval (CI) was used to evaluate the risk of mortality in COVID-19 patients with fever or dyspnea.

The robustness of the results was appraised by performing a sensitivity analysis.

Both Begg's test and Egger's test were applied to evaluate publication bias (3, 4) .

After selecting 1,589 articles, 15 articles were finally obtained for this meta-analysis. As displayed in Table 1 , data on 2,851 COVID-19 patients (2, 114 survivors and 737 non-survivors) were available in these articles. The sample size ranged from 27 to 663. Most of the articles were performed in China, with the exception of one in the UK.

We found that dyspnea was significantly associated with higher mortality in COVID-19 patients on the basis of 11 studies with 2,091 cases (OR = 4.34, 95% CI [2.68-7.05], P < 0.001; I 2 = 69.2%, P < 0.001, random-effects model) ( Figure 1A ). However, we did not observe a significant association between fever and the risk of 

Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis

Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis

Operating characteristics of a rank correlation test for publication bias

Bias in meta-analysis detected by a simple, graphical test

laboratory and imaging features of COVID-19: A systematic review and meta-analysis

Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: A single arm meta-analysis

Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis

 5 All authors report that they have no potential conflict of interest.

This study was supported by the National Natural Science Foundation of China (grant number 81973105).