Association between symptoms and severity of disease in hospitalised novel coronavirus (COVID-19) patients: A systemic review and meta-analysis

Background Symptoms of the novel coronavirus disease (COVD-19) are well known, although asymptomatic cases were also reported due to this rapidly evolving viral disease. However, there has been limited research with inconsistent findings on symptoms of COVID-19 and diseases severity. We aimed to evaluate the association between symptoms and severity of disease in confirmed COVID-19 cases by performing a meta-analysis. Methods We conducted a systematic review by searching four online databases (Medline, Web of Science, EMBASE and Cochrane library) of published studies that included symptoms of COVID-19 cases and severity of the disease between 01-Jan-2020 and 20-Apr-2020. PRISMA and MOOSE guidelines were followed, and only articles published in English were selected. We performed meta-analysis using Mantel-Haenszel random-effects model. Degree of heterogeneity among studies and quality of the selected studies were evaluated. Results Out of 153 articles identified, a total of seven articles, including 3,168 participants, met the inclusion criteria and were included. The median age of the patients was 49 years, 1818 (57.38%) were males, and 574 (18.11%) reported severe conditions. Fever was the most commonly reported symptom in the reported COVID-19 confirmed cases (87.89%, 95% CI: 83.22–81.39%), which was followed by cough, myalgia or fatigue, and less proportionally dyspnea and headache. Dyspnea was the only symptom, which was associated with severity of COVID-19 (OR 2.38, 95% CI: 1.83–3.10). Conclusions Dyspnoea was found to be associated with severity of COVID-19. People with existing respiratory illnesses, such as chronic obstructive pulmonary diseases need to be careful about the onset of such symptom and should seek medical attention.