Search results
A total of 9027 records were identified through database search. The titles and abstracts of 4855 published literature were screened after duplicates removed and then 166 articles were selected for detailed assessment. Among them, 28 studies had no clinical feature data, 88 studies did not report the clinical outcome of survivors and deaths, 15 studies had only deaths clinical outcome, 3 studies included population with possible selection bias and 2 studies were duplicated publications data. Finally, 30 studies containing 32 datasets with 5741 survivors and 1670 deaths were included to perform the meta-analysis in our study (Figure 1). All studies were from China. The details were showed in table 1.
Table 1. Studies and characteristics of COVID-19 patients included in this meta-anlysis
Study ID
|
Journal name
|
Published year
|
Study period
|
Region
|
Survivor cases (median age, years)
|
Death cases
(median age, years)
|
Female/male
|
Study Quality [19]
|
Xiaobo Yang[18]
|
The Lancet
|
2020
|
2019/12/24-2020/01/26
|
Wuhan, China
|
20 (51.9)
|
32 (64.6)
|
17/35
|
7
|
Zhibing Lu[11]
|
The Lancet
|
2020
|
2019/01/01-2019/02/15
|
Wuhan, China
|
92 (53.0)
|
31 (72.0)
|
62/61
|
7
|
Fei Zhou[12]
|
The Lancet
|
2020
|
2019/12/29-2020/01/31
|
Wuhan, China
|
137 (52.0)
|
54 (69.0)
|
72/119
|
7
|
Dawei Wang[19]
|
Research Square
|
2020
|
2020/02/10
|
Wuhan, China
|
88 (46.1)
|
19 (72.7)
|
50/57
|
7
|
Qiurong Ruan[20]
|
Intensive Care Med
|
2020
|
NA
|
Wuhan, China
|
82 (50.0)
|
68 (67.0)
|
48/102
|
6
|
Yan Deng[21]
|
National Medical Journal of China
|
2020
|
2020/01/01-2020/2/21
|
Wuhan, China
|
116 (40.0)
|
109 (69.0)
|
101/124
|
6
|
Min Chen[22]
|
Herald of Medicine
|
2020
|
2020/01/24-2020/02/08
|
Wuhan, China
|
23(49.0)
|
6(70.0)
|
NA
|
6
|
Xiaoxiong Liu[23]
|
The Lancet Respiratory Medicine
|
2020
|
2020/01/01-2020/01/31
|
Wuhan, China
|
74(48.2)
|
12(66.7)
|
51/35
|
6
|
Jin Shang[24]
|
The Lancet
|
2020
|
2019/12/27-2020/02/17
|
Hubei, China
|
226(46.0)
|
51(67.0)
|
157/120
|
7
|
Meng Luo[25]
|
Chinese Traditional and Herbal Drugs
|
2020
|
2020/01/17-2020/02/25
|
Wuhan, China
|
406(NA)
|
69(NA)
|
244/231
|
7
|
Zhongyong Chang[26]
|
Drugs & Clinic
|
2020
|
2020/01-2020/02
|
Wuhan, China
|
130(NA)
|
20(NA)
|
NA
|
6
|
Ning Tang[27]
|
Journal of Thrombosis and Haemostasis
|
2020
|
2020/01/01-2020/02/03
|
Wuhan, China
|
162(52.4)
|
21(64.0)
|
85/98
|
6
|
Tao Bai[28]
|
The Lancet Respiratory Medicine
|
2020
|
2019/12/26-2020/1/31
|
Wuhan, China
|
91(50.0)
|
36(67.0)
|
47/80
|
7
|
Mingli Yuan[29]
|
PLOS ONE
|
2020
|
2020/01/01-2020/01/25
|
Wuhan, China
|
17(55.0)
|
10(68.0)
|
14/13
|
6
|
Chengyun Liu[30]
|
The Lancet Respiratory Medicine
|
2020
|
2020/01/07-2020/02/11
|
Wuhan, China
|
283(46.4)
|
22(65.6)
|
163/142
|
7
|
Gu-qin Zhang[31]
|
The Lancet Infectious Diseases
|
2020
|
2020/01/02-2020/02/10
|
Wuhan, China
|
23(62.0)
|
9(76.0)
|
10/22
|
7
|
Bo Hu[32]
|
Research Square
|
2020
|
2020/01/08-2020/02/09
|
Wuhan, China
|
20(56.0)
|
16(66.5)
|
12/24
|
7
|
Yingjie Wu[33]
|
MedRxiv
|
2020
|
2019/12-2020/02/02
|
Wuhan, China
|
280(NA)
|
17(NA)
|
150/147
|
6
|
Shuai Zhang[34]
|
The Lancet Infectious Diseases(Manuscript Draft)
|
2020
|
2020/01/12-2020/02/03
|
Wuhan, China
|
268(56.0)
|
47(66.0)
|
140/175
|
7
|
Wen Cao [35]
|
The Lancet(Manuscript Draft)
|
2020
|
2020/01-2020/02
|
Wuhan, China
|
27(56.0)
|
34(65.0)
|
25/36
|
7
|
Sheng Zhang[36]
|
The Lancet Infectious Diseases(Manuscript Draft)
|
2020
|
2019/12/29-2020/02/17
|
Wuhan, China
|
176(49.9)
|
86(66.5)
|
122/140
|
7
|
Juyi Li[37]
|
The Lancet Infectious Diseases(Manuscript Draft)
|
2020
|
2020/01/01-2020/02/20
|
Wuhan, China
|
17(55.0)
|
42(70.0)
|
NA
|
7
|
Tao Chen[38]
|
BMJ
|
2020
|
2020/01/13-2020/02/28
|
Wuhan, China
|
161(51.0)
|
113(68.0)
|
103/171
|
7
|
Bin Zhu[39]
|
MedRxiv
|
2020
|
2020/01/29-2020/02/23
|
Wuhan, China
|
91(57.9)
|
16(68.1)
|
53/54
|
6
|
Jianfeng Xie-1[40]
|
MedRxiv
|
2020
|
2020/01-2020/02
|
Wuhan, China
|
144(56.0)
|
155(69.0)
|
155/144
|
6
|
Jianfeng Xie-2[40]
|
MedRxiv
|
2020
|
2020/01-2020/02
|
Wuhan, China
|
76(47.0)
|
69(67.0)
|
50/95
|
6
|
Meng Jiang-1[41]
|
The Lancet (Manuscript Draft)
|
2020
|
2019/12/28-2020/03/10
|
Wuhan, China
|
1516(60.0)
|
201((70.0)
|
843/874
|
7
|
Meng Jiang-2[41]
|
The Lancet (Manuscript Draft)
|
2020
|
2019/12/28-2020/03/10
|
Wuhan, China
|
161(62.1)
|
27(66.7)
|
90/98
|
7
|
Lin Fu[42]
|
The Lancet Respiratory Medicine
|
2020
|
2020/01/01-2020/01/30
|
Wuhan, China
|
166(NA)
|
34(NA)
|
101/99
|
7
|
Ning Tang[43]
|
Journal of Thrombosis and Haemostasis
|
2020
|
2020/01/01-2020/02/13
|
Wuhan, China
|
315(63.7)
|
134(68.7)
|
181/268
|
7
|
Xiaomin Luo[44]
|
EBioMedicine
|
2020
|
2020/01/30-2020/02/25
|
Wuhan, China
|
303(49.0)
|
100(71.0)
|
210/193
|
6
|
Nan Zhang[45]
|
Research Square
|
2020
|
2020/01/09-2020/02/19
|
Wuhan and Huaihua, China
|
50(62.6)
|
10(70.6)
|
17/43
|
6
|
Demographical and clinical features
Compared to COVID-19 survivors, the deaths were significantly older than survivors (MD=15.36, 95% CI: 12.90-17.82), and male showed higher risk to develop fatal outcome than female (OR=3.37, 95% CI: 2.27-5.02) (Figure 2A). The clinical symptoms including dyspnea (OR=4.63, 95% CI: 2.85-7.54), hemoptysis (OR=3.28, 95% CI: 1.36-7.91), malaise (OR=2.44, 95% CI: 1.49-3.97), sputum production (OR=1.51, 95% CI: 1.13-2.03) and fever (OR=1.33, 95% CI: 1.09-1.63) were more likely to predict the death outcome (Figure 2B). The time from onset of symptom to death was faster than the time from onset of symptom to discharge (WMD=-5.78, 95% CI: from -10.36 to -1.20) and death cases showed shorter hospital stay (WMD=-3.66, 95% CI: from -6.06 to -1.26) (Additional figure 1). The patients with chronic medical conditions were association with fatal outcome (OR=2.87, 95% CI: 2.51-3.29). Among them, coronary heart disease (OR=4.36 , 95% CI: 1.91-9.97) showed highly dangerous and followed by any of chronic medical conditions (OR=4.3, 95% CI: 2.68-7.00), COPD (OR=3.70, 95% CI: 2.03-6.73), cardiovascular disease (OR=3.45, 95% CI: 2.54-4.70), cerebrovascular disease (OR=3.41, 95% CI: 2.33-4.98), lung disease (OR=3.36, 95% CI: 2.44-4.65), malignancy (OR=2.81 , 95% CI: 1.60-4.92), hypertension (OR=2.81, 95% CI: 2.15-3.67), heart disease (OR=2.54, 95% CI: 1.64-3.93), chronic kidney disease (OR=2.17, 95% CI: 1.14-4.10), diabetes (OR=2.12, 95% CI: 1.77-2.54), smoking history (OR=1.37, 95% CI: 1.02-1.83) (Figure 4A, Additional figure 2).
Vital signs and laboratory findings
Compared to survivors, many indexes increased in deaths group, including heart rate (WMD =5.36, 95% CI: 3-7.72), respiratory rate (WMD=3.04, 95% CI: 1.95-4.13), systolic pressure (WMD=7.62, 95% CI: 2.56-12.68), leucocytes (WMD=3.47, 95% CI: 3.14-3.81), neutrophils (WMD=3.64, 95% CI: 2.87-4.42), neutrophil-to-lymphocyte ratio (WMD=9.84, 95% CI: 7.19-12.5), prothrombin time (WMD=1.05, 95% CI: 0.64-1.45), D-dimer (WMD=4.68, 95% CI: 2.94-6.42), interleukin- 6 (IL-6) (WMD=17.78, 95% CI: 10.57-25), hs-CRP (WMD=59.55, 95% CI: 42.13-76.96), procalcitonin (WMD=0.22, 95% CI: 0.12-0.32), serum ferritin (WMD=741.47, 95% CI: 566.77-916.16), high-sensitive cardiac troponin I (WMD=35.25, 95% CI: 19.67-50.82), lactate dehydrogenase (WMD=226.86, 95% CI: 177.08-276.64), creatine kinase (WMD=55.82, 95% CI: 21.02-90.61), myoglobin (WMD=102.58, 95% CI: 65.12-140.04), aspartate aminotransferase (ALT) (WMD=6.89, 95% CI: 0.56-13.21), alanine aminotransferase. (AST) (WMD=14.44, 95% CI: 10.94-17.94), serum creatinine (WMD=16.62, 95% CI: 11.69-21.54), γ-glutamyl transpeptidase (WMD=11.37, 95% CI: 3.3-19.43), total bilirubin (WMD=4.3, 95% CI: 3.18-5.42), direct bilirubin (WMD=2.61, 95% CI: 1.43-3.79) and blood urea nitrogen (WMD=3.43, 95% CI: 2.48-4.39). The decrease indexes included diastolic pressure (WMD=-6.11, 95% CI: -11.97 to -0.25), PaO2/FiO2 (WMD=-71.61, 95% CI: -134.11 to -9.11), PaO2 (WMD=-26.09, 95% CI: -38.9 to -13.29), SpO2 (WMD=-8.83, 95% CI: -12.03 to -5.62), lymphocyte (WMD=-0.31, 95% CI: -0.43 to -0.19), platelets (WMD=-41.09, 95% CI: -47.33 to -34.85), and albumin (WMD=-4.76, 95% CI: -5.14 to -4.38) (Figure 3, Additional table 2).
Complications
Nine complications were identified contributed to the fatal outcome, including sepsis (OR=184.61, 95% CI: 33.43-1019.42), shock (OR=133.76, 95% CI: 36.86-485.34), respiratory failure (OR=47.37, 95% CI: 20.65-108.66), ARDS (OR=45.24, 95% CI: 17.49-117.02), acute cardiac injury (OR=30.15, 95% CI: 12.39-73.35), secondary infection (OR=26.4, 95% CI: 14.96-46.59), acute kidney injury (OR=20.61, 95% CI: 12.86-33.02), coagulopathy (OR=19.72, 95% CI: 11.42-34.07) and acute liver injury (OR=9.67, 95% CI: 1.5-62.58) (Figure 4B, Additional figure 3).