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Alarming symptoms leading to severe COVID-19 pneumonia: a meta-analysis and validation
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  • weiping ji,
  • Jing Zhang,
  • Bishnu Gautam,
  • Xudong Du,
  • Xinxin Chen,
  • Hui Xu,
  • Xiaoling Guo,
  • Zhenzhai Cai,
  • Jun Zhang,
  • Xian Shen
weiping ji
Wenzhou Medical University Second Affiliated Hospital
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Jing Zhang
Wenzhou Medical University Second Affiliated Hospital
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Bishnu Gautam
Wenzhou Medical University Second Affiliated Hospital
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Xudong Du
Wenzhou Medical University Second Affiliated Hospital
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Xinxin Chen
Wenzhou Medical University Second Affiliated Hospital
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Hui Xu
Wenzhou Medical University Second Affiliated Hospital
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Xiaoling Guo
Wenzhou Medical University Second Affiliated Hospital
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Zhenzhai Cai
Wenzhou Medical University Second Affiliated Hospital
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Jun Zhang
University of Kansas Medical Center
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Xian Shen
Wenzhou Medical University Second Affiliated Hospital
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Abstract

Background: To identify alarming symptoms that could potentially lead to severe form of COVID-19 pneumonia (i.e. novel coronavirus pneumonia: NCP), a disease that is now having pandemic spread. Methods: Articles from PubMed, Embase, Cochrane database and Google up to 24 February 2020 were systematically reviewed. 18 publications that had documented cases of COVID-19 pneumonia were identified. The relevant data were extracted, systematically reviewed and further evaluated using meta-analysis. We define severe COVID-19 pneumonia as the disease status that requires admission to the intensive care unit (ICU) and respiratory/circulatory support, which is in align with the guideline from the World Health Organization (WHO). Results: 14 studies including 1,424 patients were considered eligible and analyzed. Symptoms such as fever (89.2%), cough (67.2%), fatigue (43.6%) were quite common; but dizziness, hemoptysis, abdominal pain and conjunctival congestion/conjunctivitis were relatively rare. The incidence of dyspnea was significantly higher in patients with severe than non-severe COVID-19 pneumonia (42.7% vs.16.3%, p<0.0001). Similarly, fever and diarrhea were also drastically more common in patients with severe form (p=0.0374 and 0.0267). Further meta-analysis using three high-quality China-based studies confirmed such findings and showed that dyspnea, fever and diarrhea were 3.53 (OR: 3.53, 95%CI: 1.95-6.38), 1.70 (OR: 1.70, 95%CI: 1.01-2.87), and 1.80 (OR: 1.80, 95%CI: 1.06-3.03) folds higher respectively in patients with severe COVID-19 pneumonia. Conclusion: Dyspnea, fever and diarrhea are significantly more prevalent in patients with severe COVID-19 pneumonia, suggesting they are alarming symptoms that warrant close attention and timely management.

Peer review status:UNDER REVIEW

03 Sep 2020Submitted to International Journal of Clinical Practice
03 Sep 2020Assigned to Editor
03 Sep 2020Submission Checks Completed
18 Sep 2020Reviewer(s) Assigned