Acute complications and mortality in hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis.

冠状病毒疾病 2019 住院患者的急性并发症和死亡率: 系统综述和荟萃分析。

  • 影响因子:5.02
  • DOI:10.1186/s13054-020-03022-1
  • 作者列表:"Potere N","Valeriani E","Candeloro M","Tana M","Porreca E","Abbate A","Spoto S","Rutjes AWS","Di Nisio M
  • 发表时间:2020-07-02

BACKGROUND:The incidence of acute complications and mortality associated with COVID-19 remains poorly characterized. The aims of this systematic review and meta-analysis were to summarize the evidence on clinically relevant outcomes in hospitalized patients with COVID-19. METHODS:MEDLINE, EMBASE, PubMed, and medRxiv were searched up to April 20, 2020, for studies including hospitalized symptomatic adult patients with laboratory-confirmed COVID-19. The primary outcomes were all-cause mortality and acute respiratory distress syndrome (ARDS). The secondary outcomes included acute cardiac or kidney injury, shock, coagulopathy, and venous thromboembolism. The main analysis was based on data from peer-reviewed studies. Summary estimates and the corresponding 95% prediction intervals (PIs) were obtained through meta-analyses. RESULTS:A total of 44 peer-reviewed studies with 14,866 COVID-19 patients were included. In general, risk of bias was high. All-cause mortality was 10% overall (95% PI, 2 to 39%; 1687/14203 patients; 43 studies), 34% in patients admitted to intensive care units (95% PI, 8 to 76%; 659/2368 patients; 10 studies), 83% in patients requiring invasive ventilation (95% PI, 1 to 100%; 180/220 patients; 6 studies), and 75% in patients who developed ARDS (95% PI, 35 to 94%; 339/455 patients; 11 studies). On average, ARDS occurred in 14% of patients (95% PI, 2 to 59%; 999/6322 patients; 23 studies), acute cardiac injury in 15% (95% PI, 5 to 38%; 452/2389 patients; 10 studies), venous thromboembolism in 15% (95% PI, 0 to 100%; patients; 3 studies), acute kidney injury in 6% (95% PI, 1 to 41%; 318/4682 patients; 15 studies), coagulopathy in 6% (95% PI, 1 to 39%; 223/3370 patients; 9 studies), and shock in 3% (95% PI, 0 to 61%; 203/4309 patients; 13 studies). CONCLUSIONS:Mortality was very high in critically ill patients based on very low-quality evidence due to striking heterogeneity and risk of bias. The incidence of clinically relevant outcomes was substantial, although reported by only one third of the studies suggesting considerable underreporting. TRIAL REGISTRATION:PROSPERO registration ID for this study is CRD42020177243 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=177243 ).


背景: 与新型冠状病毒肺炎相关的急性并发症和死亡率的发生率仍然缺乏特征。本系统评价和荟萃分析的目的是总结新型冠状病毒肺炎住院患者临床相关结局的证据。 方法: 检索MEDLINE、EMBASE、PubMed和medRxiv,检索截至 2020 年 4 月 20 日的研究,包括实验室确诊的有症状的住院成人新型冠状病毒肺炎。主要结局为全因死亡率和急性呼吸窘迫综合征 (ARDS)。次要结局包括急性心脏或肾损伤、休克、凝血功能障碍和静脉血栓栓塞。主要分析基于同行评议研究的数据。通过meta分析获得总结估计值和相应的 95% 预测区间 (pi)。 结果: 共纳入 44 项同行评审研究,14,866 例新型冠状病毒肺炎患者。总体而言,偏倚风险较高。全因死亡率总体为 10% (95% PI,2-39%; 1687/14203 例患者; 43 项研究),入住重症监护病房患者为 34% (95% PI,8-76%; 659/2368 例患者; 10 项研究),83% 例需要有创通气的患者 (95% PI,1 ~ 100%; 180/220 例;6 项研究) 和 75% 例发生ARDS的患者 (95% PI,35 ~ 94%; 339/455 例患者; 11 项研究)。ARDS平均发生率为 14% (95% PI,2-59%; 999/6322 患者; 23 项研究),急性心脏损伤发生率为 15% (95% PI,5-38%; 452/2389 患者; 10 项研究),静脉血栓栓塞 15% (95% PI,0 至 100%; 患者; 3 项研究),急性肾损伤 6% (95% PI,1 至 41%; 318/4682 患者; 15 项研究),凝血功能障碍 6% (95% PI,1 至 39%; 223/3370 患者; 9 项研究),3% 的患者出现休克 (95% PI,0 ~ 61%; 203/4309 例患者; 13 项研究)。 结论: 基于非常低质量的证据,由于显著的异质性和偏倚风险,危重患者的死亡率非常高。临床相关结局的发生率很高,尽管只有 3分之1 的研究报告了相当大的漏报。 试用注册: 本研究的PROSPERO注册ID为CRD42020177243 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=177243 )。



作者列表:["Lim J","Jeon S","Shin HY","Kim MJ","Seong YM","Lee WJ","Choe KW","Kang YM","Lee B","Park SJ"]

METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.

作者列表:["Zhang W","Du RH","Li B","Zheng XS","Yang XL","Hu B","Wang YY","Xiao GF","Yan B","Shi ZL","Zhou P"]

METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.

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作者列表:["Cheng ZJ","Shan J"]

METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.