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      Imaging and clinical features of patients with 2019 novel coronavirus SARS‐CoV‐2: A systematic review and meta‐analysis

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          Abstract

          Background

          Currently, the epidemic of coronavirus disease 2019 (COVID‐19) has begun to spread worldwide. We aim to explore reliable evidence for the diagnosis and treatment of the COVID‐19 by analyzing all the published studies by Chinese scholars on the clinical and imaging features in novel coronavirus pneumonia caused by SARS‐CoV‐2.

          Methods

          We searched five medical databases including two Chinese and three English databases for all published articles on COVID‐19 since the outbreak. A random‐effects model was designed, and the imaging and clinical data from all studies were collected for meta‐analysis.

          Results

          Overall, 31 articles and 46 959 patients were included, including 10 English articles and 21 Chinese articles. The results of meta‐analysis showed that the most common clinical manifestations were fever (87.3%; 0.838‐0.909), cough (58.1%; 0.502‐0.660), dyspnea (38.3%; 0.246‐0.520), muscle soreness or fatigue (35.5%; 0.253‐0.456), and chest distress (31.2%; −0.024 to 0.648). The main imaging findings were bilateral pneumonia (75.7%; 0.639‐0.871) and ground‐glass opacification (69.9%; 0.602‐0.796). Among the patients, the incidence that required intensive care unit (ICU) was (29.3%; 0.190‐0.395), the incidence with acute respiratory distress syndrome was (28.8%; 0.147‐0.429), the incidence with multiple organ dysfunction syndrome was (8.5%; −0.008 to 0.179), and the case fatality rate of patients with COVID‐19 was (6.8%; 0.044‐0.093).

          Conclusion

          COVID‐19 is a new clinical infectious disease that mainly causes bilateral pneumonia and lung function deteriorates rapidly. Nearly a third of patients need to be admitted to the ICU, and patients are likely to present respiratory failure or even death.

          Research Highlights

          • In 2019, coronavirus disease (covid‐19) has started to spread globally. How to quickly identify influenza and covid‐19 is the key to ensure timely and effective treatment.

          • The fever and cough were the main clinical manifestations of the patients with novel coronavirus pneumonia in China, and the main complications are respiratory failure, acute respiratory distress syndrome.

          • Nearly a third of patients need to be admitted to the ICU, and some patients are likely to cause respiratory failure or even death.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of Coronavirus Disease 2019 in China

            Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)
            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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              A Novel Coronavirus from Patients with Pneumonia in China, 2019

              Na Zhu, Dingyu Zhang, Wenling Wang … (2020)
              Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
              Article 0 comments Cited 12704 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Lijuan Xiong: lijuanxiong2016@126.com
                Kailin Cai:
                ORCID: http://orcid.org/0000-0002-2572-0907
                caikailin@hust.edu.cn
                Journal
                Journal ID (nlm-ta): J Med Virol
                Journal ID (iso-abbrev): J. Med. Virol
                Journal ID (doi): 10.1002/(ISSN)1096-9071
                Journal ID (publisher-id): JMV
                Title: Journal of Medical Virology
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0146-6615
                ISSN (Electronic): 1096-9071
                Publication date (Electronic): 10 April 2020
                Electronic Location Identifier: 10.1002/jmv.25822
                Affiliations
                [ 1 ] Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
                [ 2 ] Department of Endocrinology, Liyuan Hospital, Tongji Medical College Huazhong University of Since and Technology Wuhan Hubei China
                [ 3 ] Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
                Author notes
                [*] [* ] Correspondence Lijuan Xiong, Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei, China.

                Email: lijuanxiong2016@ 123456126.com

                Kailin Cai, Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022 Hubei, China.

                Email: caikailin@ 123456hust.edu.cn

                Author information
                http://orcid.org/0000-0002-2572-0907
                Article
                Publisher ID: JMV25822
                DOI: 10.1002/jmv.25822
                PMC ID: 7228215
                PubMed ID: 32242947
                SO-VID: 8d773bac-119b-4c31-96c9-cd7c744e7e30
                Copyright © © 2020 Wiley Periodicals, Inc.
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date received : 11 March 2020
                Date accepted : 30 March 2020
                Page count
                Figures: 7, Tables: 6, Pages: 11, Words: 5321
                Funding
                Funded by: Science and Technology Department of Hubei Province
                Award ID: 2018CFC884
                Funded by: Free Innovation Pre‐research Fund and Platform Scientific Research Fund in 2019
                Award ID: 02.03.2019‐111
                Categories
                Subject: Review
                Subject: Reviews
                Custom metadata
                source-schema-version-number 2.0
                edited-state corrected-proof
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:16.04.2020

                ScienceOpen disciplines: Microbiology & Virology
                Keywords: 2019 novel coronavirus pneumonia,clinical features,imaging finding,sars‐cov‐2
                Data availability:
                ScienceOpen disciplines: Microbiology & Virology
                Keywords: 2019 novel coronavirus pneumonia, clinical features, imaging finding, sars‐cov‐2

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