A meta-analysis of 2019 novel corona virus patient clinical characteristics and comorbidities

doi:10.21203/rs.3.rs-21831/v1

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Systematic Review

A meta-analysis of 2019 novel corona virus patient clinical characteristics and comorbidities

https://doi.org/10.21203/rs.3.rs-21831/v1

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Introduction

Being a new variant of coronavirus, detailed information regarding the virulence, its clinical characters, high risk individuals are yet to be defined. This study was done with the objective of finding out clinical features of corona infection and also studies what are the comorbidities that are associated with it.

Methods

This is a single arm meta-analysis in which relevant data were derived from searches in PubMed. It includes study papers which were written in English language and their completely published article is found. Seven articles published from 24^th Jan to 16^th March, 2020 are included in this study.

Results

The total number of patients was 1786 with 1044 males and 742 females with male to female ratio of 1.4:1. The median age of patients was 41 years). Fever was present in 88.8% cases. Dry Cough in 68% followed by fatigue in 33%. Hypertension (15.8%) is the most common comorbidity followed by cardio and cerebrovascular condition (11.7%).

Conclusion

Patients often presented with symptoms of fever, dry cough, lethargy and fatigue, muscle pain, productive cough. Similarly, patients with previous history of HTN, DM, COPD, cardio and cerebrovascular condition, immune-deficient states are at high risk of developing into the severe COVID-19 infection.

Infectious Diseases

Virology

Clinical features

Comorbidities

Diabetes

Hypertension

Novel corona Virus

Novel Corona Virus, also known as 2019-nCOV¹has been identified as the cause of outbreak of respiratory illness which originated in Wuhan Hubei Province, China and has spread to other parts of the world. This variant of corona virus is named as severe acute respiratory syndrome coronavirus 2

(SARS-CoV–2)by World Health Organization.²At present, there are 8,96,450 confirmed cases with 45,525 deaths.³In recent times, two variants of Corona Virus Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) were found to cause respiratory illness in animals and human being. The knowledge regarding this new variant is limited and studies regarding this virus are going all around the world. In this study, I have analyzed multiple studies which incorporate clinical findings in patients which were present in COVID–19 diagnosed patients. This will identify the clinical features which are commonly present in these patients and can act as a prospective detail which can be used for diagnosing patients who are suspected to be suffering from the condition.

Data for this meta-analysis were identified by searches of PubMed and references from relevant articles using the search terms ‘’novel corona virus”, ‘’Covid-19’’, and ‘’clinical features of novel corona virus’’. Total of hits were 1029. Only articles published in English between 24th Jan and 16th March, 2020 were included. 10 research papers were found which had description of clinical features. 7 papers which were published in English language were included. 2 papers were excluded from the study as one of the papers was found to be retracted and remaining two were published in language other than English and had only abstracts. Following 7 studies were included in this meta-analysis. (Table 1)

Table 1: List of research articles used for this meta-analysis

Name of research paper	Authors	Patient details (Age and Sex) (male-M, Female-F)	Journal published
Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study	Chen N et al¹	Total patients- 99 Age group-21-82 years M-67, F-32	The Lancet
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China	Huang C et al⁴	Total patients- 41 Age group-41-58 years M-30, F-11	The Lancet
Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China	Yang W et al⁵	Total patients-149 Age group-31-59 years M-81, F-68	Journal of Infection
Clinical Characteristics of Coronavirus Disease 2019 in China	Guan W et al⁶	Total patients-1099 Age group-0-65+ years M-640, F-459	New England Journal of Medicine
Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China	Wang D et al ⁷	Total patients-138 Age group-42-68 years M-75, F-63	Journal of American Medical Association
Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China	Wang Z et al⁸	Total patients-69 Age group-35-62 years M-32, F-37	Clinical Infectious Disease
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study	Zhou F et al⁹	Total patients-191 Age group-46-67 years M-119, F-72	The Lancet

Demographics and Clinical Characteristics

We obtained data regarding demographics including their age and sex distribution. The total number of patients was 1786 with 1044 males and 742 males with a male to female ratio of 1.4:1. The median age of patients were 41 years( interquartile range-0 to 82 years of age). Fever was present in 88.8% cases. The second most common symptom was dry cough present in 68% cases. Fatigue was present in 33.1% cases. Productive cough was present in 28.5%cases followed by muscle pains in 14.4% cases. Diarrhea(4.4%) ,Nausea or vomiting (4.1%), Rhinorrhea(3.2%) Chest and abdominal pain(0.15%) were among the least common cases. The clinical characteristics of patients are shown in Table 2.

Table 2: Clinical characteristics of patients with COVID-19

Clinical characteristics	Number	Percentage
Fever	1587	88.8%
Dry cough	1215	68%
Fatigue	591	33.1%
Productive Cough	510	28.5%
Shortness of Breath	303	17%
Muscle pain	257	14.4%
Sore throat	203	11.4%
Headache	183	10.2%
Diarrhea	78	4.4%
Nausea and Vomiting	74	4.1%
Rhinorrhea	57	3.2%
Chest pain	3	0.16%
Abdominal pain	2	0.11%

Similarly, multiple comorbidities were found among patients of COVID-19. Though 7 studies are included in this meta-analysis. Only six of them are included here as one did not provide information regarding co-morbidities with a total of 1717 patients. Hypertension (15.8%) is the most common comorbidity in patients suffering from COVID-19 infection. Other cardiovascular and cerebrovascular conditions were present in 11.7% patients followed by endocrine disorder primarily diabetes in 9.4% patients. The comorbidities of patients are shown in Table 3.

Table 3: Pre-existing comorbidities in patients with COVID-19

Comorbidities	Number	Percentage
Hypertension(HTN)	272	15.8%
Cardiovascular and Cerebrovascular diseases	200	11.7%
Endocrine system(Diabetes)	161	9.4%
Co-existing infection(HIV and Hepatitis B)	25	1.5%
Malignancy	25	1.5%
Respiratory system(COPD and others)	24	1.4%
Renal disorders	14	0.8%
Immunodeficiency states	2	0.01%

COVID-19, new variant of Corona Virus, is an enveloped virus with helical nucleo-capsid that contains single stranded RNA and have distinctive club-shaped surface projections that give appearance of a solar corona to the virion named for Crown like spikes proteins around the lipid envelope.⁹Though, exact genetic composition and its variation has not be decrypted. Multiple of published studies show that Novel corona Virus(COVID-19) is sufficiently different from SARS corona virus and is hence a new variant of beta-coronavirus. This novel corona virus might be linked to a zoonotic pathogen. It has been said that this virus might have originated from a zoonotic pathogen as the virus isolated from the affected patient showed the similar corona virus sequence EPI_ISL_402131which is also found in Rhinolophus affinis, an Asian bat predominantly found in China. At least 96% similarity was found between corona virus genome and that of bat relative, however, similarity with the human strain of SARS is much lower of around 80%. Although zoonotic origin of virus is seen, animals sold at the sea food market in Wuhan might represent an intermediate host facilitating the emergence of virus in humans.^{10,11,12,13,34,36,37,38}

In this study, it has been found that fever and cough( both dry and productive), fatigue, shortness of breath and muscle aches were found to be the major symptoms in patients who were diagnosed to be suffering from COVID-19. One of the published retrospective study by Yang et al¹⁴, showed that fever, cough and shortness of breath were major symptoms in patients of COVID-19 pneumonia. Centre for disease control(CDC) also listed these symptoms to be the major symptoms.¹⁵Another studies showed that fever, cough and vomiting were among the most common symptoms.¹⁶Similar findings were shown in multiple of other studies.^{17,18,19,20,21,28,29,30,31,32,33,35,}

Similarly, this study shows that the extent of disease severity is largely dependent in patient comorbid conditions. This study shows that Hypertension(HTN), other cardiovascular and cerebrovascular diseases, diabetes mellitus(DM), respiratory disorders like Chronic Obstructive Pulmonary Disease(COPD), other concurrent infections and immunodeficiency states are among major co-morbidities present in individuals suffering fromCOVID-19. In a systematic review by Yang J et al²², HTN,DM, cardiovascular and cerebrovascular conditions, COPD, malignancy and immunosuppressed states were shown among others as the important risk factors. Angiotensin Converting Enzyme inhibitors which is generally used in HTN has warranted a specific concern ⁴², however, substantial findings are yet to be found. Angiotensin converting enzyme 2 (ACE2) receptors have been shown to be the entry point into human cells for SARS-CoV-2, the virus that causes COVID-19. In a few experimental studies with animal models, both angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to upregulate ACE2 expression in the heart. Though these have not been shown in human studies, or in the setting of COVID-19.²³Multiple of published reports show that Diabetes^39,40,41, Hypertension^{43,44,45,46,47}and Cardiovascularconditions^45,46,47, Immunosuppressed states^48,49,50,51, gastric conditions are among the most common co-morbidities that leads to increased infection, virulence and fatality when an individual is affected by Novel Corona Virus.^22,24,

Novel Corona Virus is the recent outbreak of new form of Corona Virus whose exact determinants are yet to be found. But it is certain that it causes variety of clinical conditions which manifests in the form of fever, cough, shortness of breath, muscle pain and fatigue, abdominal pain, nausea and vomiting. It is also found that milder forms may be found in previously healthy individuals as compared to those who had pre-existing conditions like hypertension, diabetes, arrhythmias, COPD, immunodeficiency states and concurrent infections.

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You are reading this latest preprint version

A meta-analysis of 2019 novel corona virus patient clinical characteristics and comorbidities

Status:

Version 1

Abstract

Introduction

Methods

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

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

Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China

Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Results

Demographics and Clinical Characteristics

Discussion

Conclusion

References

Status:

Version 1