Prevalence and correlation of symptoms and comorbidities in COVID-19 patients: A systematic review and meta-analysis

Background

The COVID-19 affected millions of people, and the patients present a constellation of symptoms and comorbidities. We aimed to chronicle the prevalence and correlations of symptoms and comorbidities, and associated covariates among the patients.

Methods

We performed a systematic review and meta-analysis [PROSPERO registration: CRD42020182677]. Databases [PubMed, SCOPUS, EMBASE, WHO, Semantic Scholar, and COVID-19 Primer] were searched for clinical studies published in English from January 1 to April 20, 2020. The pooled prevalence of symptoms and comorbidities were identified using the random effect model, and sub-groups analysis of patients’ age and locations were investigated. A multivariable factor analysis was also performed to show the correlation among symptoms, comorbidities and age of the COVID-19 patients.

Findings

Twenty-nine articles [China (24); Outside of China (5)], with 4,884 COVID-19 patients were included in this systematic review. The meta-analysis investigated 33 symptoms, where fever [84%], cough/dry cough [61%], and fatigue/weakness [42%] were found frequent. Out of 43 comorbidities investigated, acute respiratory distress syndrome (ARDS) [61%] was a common condition, followed by hypertension [23%] and diabetes [12%]. According to the patients’ age, the prevalence of symptoms like fatigue/weakness, dyspnea/shortness of breath, and anorexia were highly prevalent in older adults [≥50 years] than younger adults [≤50 years]. Diabetes, hypertension, coronary heart disease, and COPD/lung disease were more prevalent comorbidities in older adults than younger adults. The patients from outside of China had significantly higher prevalence [p< 0.005] of diarrhea, fatigue, nausea, sore throat, and dyspnea, and the prevalent comorbidities in that region were diabetes, hypertension, coronary heart disease, and ARDS. The multivariable factor analysis showed positive association between a group of symptoms and comorbidities, and with the patients’ age.

Interpretation

Epitomizing the correlation of symptoms of COVID-19 with comorbidities and patients’ age would help clinicians effectively manage the patients.

Summary box

What is already known?

• There is scarce evidence on the prevalence of all symptoms and comorbidities in COVID-19 infected older adults and patients from outside of China.

• Previously published review studies excluded a wide range of symptoms and comorbidities from their analysis due to limited time-frame.

• Study on the correlation of symptoms and comorbidity with age of the COVID-19 patients are not yet to be explored.

What are the new findings?

• We investigated all the reported symptoms [33] and comorbidity [43] where fever [84%], cough/dry cough [61%], fatigue/weakness [42%] and dyspnea/shortness of breath [ symptoms, and ARDS [61%], followed by hypertension [23%] and frequent comorbidity.

• Key findings, the fatigue/weakness, dyspnea/shortness of breath and anorexia were comparatively higher in older adults than younger adults, and the patients from outside of China had a higher prevalence diarrhoea, fatigue, nausea, sore throat, dyspnea, diabetes, hypertension, coronary heart disease and ARDS.

• Key findings, the symptoms comprising fever, dyspnea/shortness of breath, nausea, vomiting, abdominal pain, dizziness, anorexia and pharyngalgia; and the comorbidities including diabetes, hypertension, coronary heart disease, COPD/lung disease and ARDS were positively correlated with the COVID-19 patient’s age.

What do the new findings imply?

• These findings according to patient’s age and geographical variations may help the health care providers and policy makers.

• This pioneering efforts in estimating the prevalence and correlations of all frequent symptoms and comorbidities will help the clinicians and disease practitioners like WHO to implement patient-centered interventions.