Critical complications of COVID-19: A descriptive meta-analysis study

doi:10.31083/j.rcm.2020.03.129

Reviews in Cardiovascular Medicine

2020, Vol. 21

Issue (3): 433-442 DOI: 10.31083/j.rcm.2020.03.129

Systematic Review

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Critical complications of COVID-19: A descriptive meta-analysis study

Kimia Vakili¹, Mobina Fathi¹, Aiyoub Pezeshgi², Ashraf Mohamadkhani³, Mohammadreza Hajiesmaeili^4,^*(

), Mostafa Rezaei-Tavirani^5,^*(

), 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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Abstract:

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; I ${}^{2}$ = 97.74%), cough: 63.01% (95% CI: 57.63-68.23; I ${}^{2}$ = 93.73%), dyspnea: 37.16% (95% CI: 27.31-47.57%; I ${}^{2}$ = 98.32%), fatigue: 34.22% (95% CI: 26.29-42.62; I ${}^{2}$ = 97.29%), and diarrhea: 11.47% (95% CI: 6.96-16.87; I ${}^{2}$ = 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; I ${}^{2}$ = 98.56%), arrhythmia with 16.64% (95% CI: 9.34-25.5; I ${}^{2}$ = 92.29%), acute cardiac injury with 15.68% (95% CI: 11.1-20.97; I ${}^{2}$ = 92.45%), heart failure with 11.50% (95% CI: 3.45-22.83; I ${}^{2}$ = 89.48%), and acute kidney injury (AKI) with 9.87% (95% CI: 6.18-14.25; I ${}^{2}$ = 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: mrhajiesmaeili@sbmu.ac.ir;tavirany@yahoo.com

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	Kimia Vakili
	Mobina Fathi
	Aiyoub Pezeshgi
	Ashraf Mohamadkhani
	Mohammadreza Hajiesmaeili
	Mostafa Rezaei-Tavirani
	Fatemeh Sayehmiri

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.

URL:

https://rcm.imrpress.com/EN/10.31083/j.rcm.2020.03.129 OR https://rcm.imrpress.com/EN/Y2020/V21/I3/433

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	I ${}^{2}$ (%)	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)
Gender
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
Complications
Respiratory
ARDS	27	33.15	(23.35-43.73)	98.56	0.00
Cardiovascular
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
Renal
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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