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Reviews in Cardiovascular Medicine  2020, Vol. 21 Issue (3): 433-442     DOI: 10.31083/j.rcm.2020.03.129
Systematic Review Previous articles | Next articles
Critical complications of COVID-19: A descriptive meta-analysis study
Kimia Vakili1, Mobina Fathi1, Aiyoub Pezeshgi2, Ashraf Mohamadkhani3, Mohammadreza Hajiesmaeili4, *(), Mostafa Rezaei-Tavirani5, *(), Fatemeh Sayehmiri1
1Student research committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, 198571743, Tehran, IR Iran
2Faculty of Medicine, Zanjan University of Medical Sciences, 83153-45139, Zanjan, IR Iran
3Digestive Disease Research Center, Tehran University of Medical Sciences, 1411713135, Tehran, IR Iran
4Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, 198571743, Tehran, IR Iran
5Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, 198571743, Tehran, IR Iran
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The coronavirus disease 2019 (COVID-19) is a novel coronavirus infection that has rapidly spread worldwide, causing a pandemic. The main objective of this meta-analysis was to evaluate the prevalence of the most common symptoms and complications of COVID-19. All relevant studies on the clinical complications of COVID-19 have been identified by searching two web databases (i.e., PubMed and Scopus). Afterward, the relevant data were extracted from the selected studies, and then analyzed by the STATA (Version 14) random-effects model. The 30 studies selected for our meta-analysis covered 6,389 infected patients. The prevalence rates of the most common symptoms were as follows: fever: 84.30% (95% CI: 77.13-90.37; I2 = 97.74%), cough: 63.01% (95% CI: 57.63-68.23; I2 = 93.73%), dyspnea: 37.16% (95% CI: 27.31-47.57%; I2 = 98.32%), fatigue: 34.22% (95% CI: 26.29-42.62; I2 = 97.29%), and diarrhea: 11.47% (95% CI: 6.96-16.87; I2 = 95.58%). Moreover, the most prevalent complications were found to be acute respiratory distress syndrome (ARDS) with 33.15% (95% CI: 23.35-43.73; I2 = 98.56%), arrhythmia with 16.64% (95% CI: 9.34-25.5; I2 = 92.29%), acute cardiac injury with 15.68% (95% CI: 11.1-20.97; I2 = 92.45%), heart failure with 11.50% (95% CI: 3.45-22.83; I2 = 89.48%), and acute kidney injury (AKI) with 9.87% (95% CI: 6.18-14.25; I2 = 95.64%). In this study, we assessed the prevalence of the main clinical complications of COVID-19, and found that following respiratory complications, cardiac and renal complications are the most common clinical complications of COVID-19.

Key words:  COVID-19      ARDS      acute cardiac injury      acute kidney injury (AKI)     
Submitted:  06 July 2020      Revised:  21 September 2020      Accepted:  25 September 2020      Published:  30 September 2020     
*Corresponding Author(s):  Mohammadreza Hajiesmaeili,Mostafa Rezaei-Tavirani     E-mail:;

Cite this article: 

Kimia Vakili, Mobina Fathi, Aiyoub Pezeshgi, Ashraf Mohamadkhani, Mohammadreza Hajiesmaeili, Mostafa Rezaei-Tavirani, Fatemeh Sayehmiri. Critical complications of COVID-19: A descriptive meta-analysis study. Reviews in Cardiovascular Medicine, 2020, 21(3): 433-442.

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Fig. 1.  Study flow diagram. To find eligible cross-sectional and case-control studies, a 5 step screening process was conducted (based on PRISMA checklist).

Table 1.  Baseline characteristics of studies included in this meta-analysis
Study (ref) Place Patients (No.) Age (Median) Symptoms (P.) Complications (P.) Mortality (%)
All Male Female Fever Cough Fatigue Diarrhea Dyspnea Acute Cardiac Injury AKI ARDS
Zhou et al.,2020 China 191 119 72 56 94 79 23 5 29 17 15 54 28
Du et al.,2020 China 85 62 23 92 22 59 19 59 5 47
L. Wang et al.,2020 China 339 166 173 69 92 53 40 13 41 21 8 21 19
X. Li et al.,2020 China 25 10 15 73 92 92 100
N. Chen et al.,2020 China 99 67 32 83 82 11 2 31 3 17 11
D. Wang et al.,2020 China 138 75 63 99 59 70 10 31 7 4 20 4
Guan et al.,2020 China 1099 637 459 47 44 68 38 4 19 0.5 3 1
X. Yang et al.,2020 China 52 35 17 98 77 12 64 30 67 62
Guo et al.,2020 China 187 91 96 15 25 23
Y. Liu et al.,2020 China 12 8 4 83 92 33 17 50
W. Liu et al.,2020 China 78 39 39 38 44 26
Z. Li et al.,2020 China 193 95 98 57 89 69 39 18 36 12 28 28 66
T. Chen et al.,2020 China 274 171 103 62 91 68 50 28 44 44 11 72 41
J. Zhang et al.,2020 China 82 54 28 72.5 78 65 46 12 63 100
Shi et al.,2020a China 416 205 211 64 80 35 13 4 28 2 23 14
L. Wang et al.,2020 China 116 67 49 54 10
Arentz et al.,2020 USA 21 11 52 48 76 2 52
T. Chen et al.,2020 China 203 108 95 54 89 60 8 2 13
G. Zhang et al.,2020 China 221 108 113 55 91 61 71 11 29 8 5 22 5
Cao et al.,2020 China 102 53 49 54 81 49 55 11 34 15 20 20 17
Hu et al.,2020 China 323 166 157 61 84 51 4 7 5 4
Huang et al.,2020 China 41 30 11 49 98 76 44 3 55 12 0.7 29 15
X. C. Li et al.,2020 China 548 279 269 60 95 76 47 33 57 22 17 38 17
Lian et al.,2020 China 136 58 78 85 63 18 13 2 17 0
Lian et al.,2020 China 652 349 303 80 65 18 3 2 5 0
S. Wan et al.,2020 China 135 72 63 47 89 77 33 13 13 7 4 16 0.7
Deng et al.,2020 China 112 57 55 65 88 71 56 13 0
Shao et al.,2020 China 136 90 46 38 52 49 20 75 0
Tu et al.,2020 China 25 19 6 70 72 76 92 100
Tu et al.,2020 China 149 60 89 51 5 5 5 0
F. Yang et al.,2020 China 91 49 43 34 17 80 100
Yao et al.,2020 China 108 43 65 52 74 78 26 8 14 7 15 42 11
*Abbreviations: No = Number; P = prevalence.
Fig. 2.  Forest Plot of the prevalence of acute cardiac injury in COVID-19 patients. Each square shows effect estimate of individual studies with their 95% CI. Size of squares is proportional to the weight of each study in the meta-analysis. In this plot, studies are shown in the order of publication date and first author’s names (based on a random effects model).

Fig. 3.  Forest Plot of the prevalence of acute kidney injury (AKI) in COVID-19 patients. Each square shows effect estimate of individual studies with their 95% CI. Size of squares is proportional to the weight of each study in the meta-analysis. In this plot, studies are shown in the order of publication date and first author’s names (based on a random effects model).

Table 2.  Statistical analysis of reviewed studies
Number of study Prevalence (%) 95% CI I2 (%) P Value for heterogeneity
Mortality 22 12.29 (6.20-19.99) 98.29 0.00
Mortality in China 21 11.20 (5.36-18.75) 98.34 0.00
Mortality in USA 1 52.38 (29.78-74.29)
Female 29 45.29 (42.61-47.99) 74.56 0.00
Male 29 54.72 (52.04-57.39) 74.33 0.00
Clinical Manifestations
Fever 24 84.30 (77.13-90.37) 97.74 0.00
Cough 25 63.01 (57.63-68.23) 93.73 0.00
Dyspnea 23 37.16 (27.31-47.57) 98.32 0.00
Fatigue 21 34.22 (26.29-42.62) 97.29 0.00
Diarrhea 18 11.47 (6.96-16.87) 95.58 0.00
ARDS 27 33.15 (23.35-43.73) 98.56 0.00
Acute Cardiac injury 15 15.68 (11.01-20.97) 91.36 0.00
Arrhythmia 5 16.64 (9.34-25.50) 92.29 0.00
Heart failure 4 11.50 (3.45-22.83) 89.48 0.00
AKI 21 9.87 (6.18-14.25) 95.64 0.00
Fig. 4.  Begg’s funnel plot for publication bias.

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