key: cord-1024081-o56j4qio
authors: Yang, Jing; Zheng, Ya; Gou, Xi; Pu, Ke; Chen, Zhaofeng; Guo, Qinghong; Ji, Rui; Wang, Haojia; Wang, Yuping; Zhou, Yongning
title: Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis
date: 2020-03-12
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2020.03.017
sha: 4090d8537051fae501355bc567dc2dec620762eb
doc_id: 1024081
cord_uid: o56j4qio

Abstract Background An outbreak of Novel Coronavirus (COVID -19) in Wuhan, China, the epidemic is more widespread than initially estimated, with cases now confirmed in multiple countries. Aims The aim of the meta-analysis was to assess the prevalence of comorbidities in the COVID-19 infection patients and the risk of underlying diseases in severe patients compared to non-severe patients. Methods A literature search was conducted using the databases PubMed, EMBASE, and Web of sciences until February 25, 2020. Risk ratio (OR) and 95% confidence intervals (CIs) were pooled using random-effects models. Results Eight studies were included in the meta- analysis, including 46248 infected patients. The result showed the most prevalent clinical symptom was fever ( 91 ± 3, 95% CI 86-97% ), followed by cough (67 ± 7, 95% CI 59-76%), fatigue ( 51 ± 0, 95% CI 34-68% ) and dyspnea ( 30 ± 4, 95% CI 21-40%). The most prevalent comorbidity were hypertension (17 ± 7, 95% CI 14-22%) and diabetes ( 8 ± 6, 95% CI 6-11% ), followed by cardiovascular diseases ( 5 ± 4, 95% CI 4-7% ) and respiratory system disease( 2 ± 0, 95% CI 1-3% ). Compared with the Non-severe patient, the pooled odds ratio of hypertension, respiratory system disease, cardiovascular disease in severe patients were (OR 2.36, 95% CI: 1.46-3.83), (OR 2.46, 95% CI: 1.76-3.44) and (OR 3.42, 95% CI: 1.88-6.22)respectively. Conclusion We assessed the prevalence of comorbidities in the COVID-19 infection patients and found underlying disease, including hypertension, respiratory system disease and cardiovascular, may be a risk factor for severe patients compared with Non-severe patients.

On December 31, 2019, a cluster of cases of "pneumonia of unknown origin" in people associated with the Huanan Seafood Wholesale Market has been reported in Wuhan, China. Only a few days later, Chinese health authorities confirmed that this cluster was associated with a Novel Coronavirus 1 of them had comorbidities. Importantly, the patients admitted to the intensive care unit (ICU) had a higher number of comorbidities(72.2%) than those not admitted to the ICU(37.3%). This suggests that complications may be a risk factor for adverse outcomes 4 . Assessing the prevalence of these chronic diseases is the basis for mitigating complications in patients with COVID-19 infections. However, the effort was hampered by the limited number of cases.

To get a more convincing result, we will provide a systematic evaluation and detail not only estimate the Prevalence of comorbidities in all patients, also assess the risk of underlying diseases in severe patients compared to non-severe patients. The result may aid the management while developing policies for prevention, and response to COVID-19 and its critical outcomes. 

The two investigators (J Yang and YP Wang) who performed the literature search also independently extracted the data from included studies. Disagreements were resolved with a third investigator (YN Zhou) or by consensus. We extracted the following variables: author, date, age, gender, number of participates in severe and Non-severe, the prevalence of clinical symptoms such as fever, cough, fatigue, and dyspnea, together with comorbidities including hypertension, diabetes, respiratory system disease, and cardiovascular diseases. All calculations were performed by STATA MP version 13.0. The odds ratio (OR, 95% confidence intervals (CI)) was used to describe the ratio of the probability of the Coronavirus occurring in severe patients vs.

Non-severe. Owing to heterogeneity within and between studies, a random effect model was used to estimating the average effect and its precision, which would give a more conservative estimate of the 95% CI. Using the I 2 statistic and Cochran's Q test to assess statistical heterogeneity.

Terms initially searched a total of 108 articles. After we removed duplicates, checked the title and abstract, and reviewed full-text, eight studies 3-10 eventually met the predetermined inclusion and exclusion criteria. As of February 25, 2020, a total of J o u r n a l P r e -p r o o f 46248 participants were included in our meta-analysis. As presented in Table 1 , the median age was 46.0 years and 23871 (51.6%) were men.

The result of this meta-analysis showed the most prevalent clinical symptom was fever ( 91±3, 95% CI 86-97% ), followed by cough (67±7, 95% CI 59-76%), fatigue ( 51±0, 95% CI 34-68% ) and dyspnea ( 30±4, 95% CI 21-40% ). However, the I 2 varying from 84.9% to 96.4% in the evaluates of the clinical features showed significant statistic heterogeneity (p=0.00). The prevalence of comorbidities including hypertension, diabetes, respiratory system disease, and cardiovascular diseases. As shown in Figure 2 (inserts A, B, C, D), the most prevalent comorbidity were hypertension ( 17±7, 95% CI 14-22% ) and diabetes ( 8±6, 95% CI 6-11% ),followed by cardiovascular diseases ( 5±4, 95% CI 4-7% ) and respiratory system disease( 2±0, 95% CI 1-3% ). In analysis by the proportion of comorbidities, the significant heterogeneity observed for estimates of hypertension, diabetes and cardiovascular diseases (p=0.000), but not respiratory system disease (p=0.126) with an I 2 index ranging from 39.9 to 87.5%.

In Figure 3 , we analyzed the relationship between complications and severe group and Non-severe group. A higher risk of with hypertension, respiratory system disease, and cardiovascular diseases in the severe group compared to those in Non-severe, the result were (OR 2.36, 95% CI: 1.46-3.83), (OR 2.46, 95% CI: 1.76-3.44) and (OR 3.42, 95% CI: 1.88-6.22)respectively. They showed low heterogeneity, with I 2 from 0 to 39.3 %. However, it was not a statistically significant difference in diabetes, (OR 2.07, 95% CI: 0.89-4.82).

The meta-analysis was based on data from 8 studies with laboratory-confirmed COVID -19. All the cases were from hospitals in China. The result we observed more men than women, statistics about 23871:22377 in the COVID-19 infection. MERS-CoV and SARS-CoV have also been found to infect more males than females 11, 12 . It is customary to think women are less likely to affect many bacteria and viruses than men, partly because of their more robust innate and adaptive immune responses 13 .

However, it may be related to the occupational risk factors for men in Huanan wet market exposure history in Huang's report 3 . Aged people and severe patients are more susceptible to COVID-19, this may be associated with a higher frequency of comorbidities 9 .

A meta-analysis of the comorbidities suggests that hypertension prevalent in approximately 17% of the patients, diabetes, cardiovascular diseases, and respiratory system disease were present in 8%, 5%, and 2% of the cases, respectively.

Hypertension, diabetes mellitus consistent with the prevalence of hypertension and diabetes in China were 23.2% 14 16 . The comorbidities effect had also been noted to have similar effects in other respiratory illnesses, such as MERS-CoV 11 . In our study, the association also showed in hypertension, cardiovascular diseases, and respiratory system disease group. Overall, the severe patients were older 4 and had a more significant number of comorbid conditions than those Non-severe. These results suggest that age and comorbidities may be risk factors for critical patients.

The diseases such as hypertension, diabetes, respiratory system disease, 

The study does not require ethical approval because the meta-analysis are based on published research and the original data are anonymous.

The authors declared that they have no conflicts of interest to this work. 

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