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.