Determine the most common clinical symptoms in COVID-19 patients: a systematic review and meta-analysis


Clinical Symptoms, COVID-19, Meta-analysis


Introduction: COVID-19 is an emerging infectious disease. The study about features of this infection could be very helpful in better knowledge about this infectious disease. The current systematic review and meta-analysis were aimed to estimate the prevalence of clinical symptoms of COVID-19 in a systematic review and meta-analysis.

Methods: A systematic review using Medline/PubMed, Scopus, and Google scholar has been conducted. In the current systematic review and meta-analysis, the articles published in the period January 1, 2020, to April 2, 2020, written in English and reporting clinical symptoms of COVID-19 was reviewed. To assess, the presence of heterogeneity, the Cochran’s Q statistic, the I2 index, and the tau- squared test were used. Because of significant heterogeneity between the studies the random-effects model with 95% CI was used to calculate the pooled estimation of each symptom prevalence.

Results: The most common symptoms in COVID-19 patients include: Fever 81.2% (95% CI: 77.9-84.4); Cough: 58.5% (95% CI: 54.2-62.8); Fatigue 38.5% (95% CI: 30.6-45.3); Dysp- nea: 26.1% (95% CI: 20.4-31.8); and the Sputum: 25.8% (95% CI: 21.1-30.4). Based on the meta-regression results, the sample size used in different studies did not have a significant effect on the final estimate value (P > 0.05).

Conclusion: Considering the main symptoms of COVID-19 such as Fever, Cough, Fatigue, and Dyspnea can have a key role in early detection of this disease and prevent the transmission of the disease to other people.


1. Bonilla-Aldana D, Dhama K, Rodriguez-Morales AJAAVS: Revisiting the One Health Approach in the Context of COVID-19: A look into the Ecology of this Emerging Disease. 2020, 8(3):234-237.
2. Drosten C, Günther S, Preiser W, Van Der Werf S, Brodt H-R, Becker S, Rabenau H, Panning M, Kolesnikova L, Fouchier RAJNEjom: Identification of a novel coronavirus in patients with severe acute respiratory syndrome. 2003, 348(20):1967-1976.
3. Alimohamadi Y, Taghdir M, Sepandi MJJoPM, Health P: The Estimate of the Basic Reproduction Number for Novel Coronavirus disease (COVID-19): A Systematic Review and Meta-Analysis. 2020.
4. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, Ma K, Xu D, Yu H, Wang HJB: Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. 2020, 368.
5. Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD: How will country-based mitigation measures influence the course of the COVID-19 epidemic? The Lancet 2020, 395(10228):931-934.
6. Guo Y-R, Cao Q-D, Hong Z-S, Tan Y-Y, Chen S-D, Jin H-J, Tan K-S, Wang D-Y, Yan Y: The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Military Medical Research 2020, 7(1):1-10.
7. Organization WH: Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). 2020. In.; 2020.
8. Case Series Studies Quality Appraisal Checklist []
9. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong YJJ: Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. 2020.
10. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu XJTL: Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. 2020, 395(10223):497-506.
11. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei YJTL: Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. 2020, 395(10223):507-513.
12. Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, Cui J, Xu W, Yang Y, Fayad ZAJR: CT imaging features of 2019 novel coronavirus (2019-nCoV). 2020:200230.
13. Chen L, Liu H, Liu W, Liu J, Liu K, Shang J, Deng Y, Wei SJZjhhhxzzZjhhzCjot, diseases r: Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia. 2020, 43:E005-E005.
14. Kui L, Fang Y-Y, Deng Y, Liu W, Wang M-F, Ma J-P, Xiao W, Wang Y-N, Zhong M-H, Li C-HJCmj: Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. 2020.
15. Chang D, Lin M, Wei L, Xie L, Zhu G, Cruz CSD, Sharma LJJ: Epidemiologic and clinical characteristics of novel coronavirus infections involving 13 patients outside Wuhan, China. 2020.
16. intelligence C-NIRSTJCd: COVID-19, Australia: Epidemiology Report 6 (Reporting week ending 19: 00 AEDT 7 March 2020). 2020, 44.
17. Liu YSL, Zhang D, Tang S, Chen H, Chen L, He X, Tong M, Liu M, Lin Y, Zhu BJC: The Epidemiological and Clinical Characteristics of 2019 Novel Coronavirus Infection in Changsha, China. 2020.
18. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, Zheng D, Wang J, Hesketh RL, Yang LJR: Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. 2020:200370.
19. Zhang M, Wang X, Chen Y, Zhao K, Cai Y, An C, Lin M, Mu XJZjhhhxzzZjhhzCjot, diseases r: Clinical features of 2019 novel coronavirus pneumonia in the early stage from a fever clinic in Beijing. 2020, 43(3):215-218.
20. Feng K, Yun Y, Wang X, Yang G, Zheng Y, Lin C, Wang LJZekzzCjop: Analysis of CT features of 15 children with 2019 novel coronavirus infection. 2020, 58:E007.
21. Wang X, Yuan J, Zheng Y, Chen J, Bao Y, Wang Y, Wang L, Li H, Zeng J, Zhang YJZekzzCjop: Clinical and epidemiological characteristics of 34 children with 2019 novel coronavirus infection in Shenzhen. 2020, 58:E008.
22. Yang X, Yu Y, Xu J, Shu H, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu TJTLRM: Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. 2020.
23. Wu J, Wu X, Zeng W, Guo D, Fang Z, Chen L, Huang H, Li CJIR: Chest CT findings in patients with corona virus disease 2019 and its relationship with clinical features. 2020, 10.
24. Zhao Z, Xie J, Yin M, Yang Y, He H, Jin T, Li W, Zhu X, Xu J, Zhao CJm: Clinical and Laboratory Profiles of 75 Hospitalized Patients with Novel Coronavirus Disease 2019 in Hefei, China. 2020.
25. Zhao W, Yu S, Zha X, Wang N, Pang Q, Li T, Li AJm: Clinical characteristics and durations of hospitalized patients with COVID-19 in Beijing: a retrospective cohort study. 2020.
26. Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, Dai J, Sun Q, Zhao F, Qu JJJoI: Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): A multi-center study in Wenzhou city, Zhejiang, China. 2020.
27. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, Lee MJJ: Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. 2020.
28. Huang Y, Zhou H, Yang R, Xu Y, Feng X, Gong PJm: Clinical characteristics of 36 non-survivors with COVID-19 in Wuhan, China. 2020.
29. Jian-ya GJm: Clinical characteristics of 51 patients discharged from hospital with COVID-19 in Chongqing, China. 2020.
30. Zhang Jj, Dong X, Cao YY, Yuan Yd, Yang Yb, Yan Yq, Akdis CA, Gao YdJA: Clinical characteristics of 140 patients infected by SARS‐CoV‐2 in Wuhan, China. 2020.
31. Yan S, Song X, Lin F, Zhu H, Wang X, Li M, Ruan J, Lin C, Liu X, Wu QJm: Clinical Characteristics of Coronavirus Disease 2019 in Hainan, China. 2020.
32. Wu J, Liu J, Zhao X, Liu C, Wang W, Wang D, Xu W, Zhang C, Yu J, Jiang BJCID: Clinical characteristics of imported cases of COVID-19 in Jiangsu province: a multicenter descriptive study. 2020.
33. Xu Y, Li Y-r, Zeng Q, Lu Z-b, Li Y-z, Wu W, Dong S-y, Huang G, Wang X-hJm: Clinical characteristics of SARS-CoV-2 pneumonia compared to controls in Chinese Han population. 2020.
34. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X et al: Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England) 2020, 395(10229):1054-1062.
35. Cheng Z, Lu Y, Cao Q, Qin L, Pan Z, Yan F, Yang WJAJoR: Clinical Features and Chest CT Manifestations of Coronavirus Disease 2019 (COVID-19) in a Single-Center Study in Shanghai, China. 2020:1-6.
36. Li J, Song H, Hu ZJm: Clinical features and outcomes of 2019 novel coronavirus-infected patients with cardiac injury. 2020.
37. Liu Y, Sun W, Li J, Chen L, Wang Y, Zhang L, Yu LJm: Clinical features and progression of acute respiratory distress syndrome in coronavirus disease 2019. 2020.
38. Xu Y, Xu Z, Liu X, Cai L, Zheng H, Huang Y, Zhou L, Huang L, Lin Y, Deng LJm: Clinical findings in critical ill patients infected with SARS-Cov-2 in Guangdong Province, China: a multi-center, retrospective, observational study. 2020.
39. Wang L, He W, Yu X, Hu D, Bao M, Liu H, Zhou J, Jiang HJJoI: Coronavirus Disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. 2020.
40. Feng Z, Yu Q, Yao S, Luo L, Duan J, Yan Z, Yang M, Tan H, Ma M, Li TJm: Early Prediction of Disease Progression in 2019 Novel Coronavirus Pneumonia Patients Outside Wuhan with CT and Clinical Characteristics. 2020.
41. Qian G-Q, Yang N-B, Ding F, Ma AHY, Wang Z-Y, Shen Y-F, Shi C-W, Lian X, Chu J-G, Chen LJm: Epidemiologic and Clinical Characteristics of 91 Hospitalized Patients with COVID-19 in Zhejiang, China: A retrospective, multi-centre case series. 2020.
42. Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, Ng O-T, Marimuthu K, Ang LW, Mak TMJJ: Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. 2020.
43. Wen Y, Wei L, Li Y, Tang X, Feng S, Leung K, Wu X, Pan X-F, Chen C, Xia JJm: Epidemiological and clinical characteristics of COVID-19 in Shenzhen, the largest migrant city of China. 2020.
44. Liao J, Fan S, Chen J, Wu J, Xu S, Guo Y, Li C, Zhang X, Wu C, Mou HJm: Epidemiological and clinical characteristics of COVID-19 in adolescents and young adults. 2020.
45. Chen X, Zheng F, Qing Y, Ding S, Yang D, Lei C, Yin Z, Zhou X, Jiang D, Zuo QJm: Epidemiological and clinical features of 291 cases with coronavirus disease 2019 in areas adjacent to Hubei, China: a double-center observational study. 2020.
46. Yang P, Ding Y, Xu Z, Pu R, Li P, Yan J, Liu J, Meng F, Huang L, Shi LJm: Epidemiological and clinical features of COVID-19 patients with and without pneumonia in Beijing, China. 2020.
47. Liu J, Ouyang L, Guo P, sheng Wu H, Fu P, liang Chen Y, Yang D, yu Han X, kun Cao Y, Alwalid OJm: Epidemiological, Clinical Characteristics and Outcome of Medical Staff Infected with COVID-19 in Wuhan, China: A Retrospective Case Series Analysis. 2020.
48. Fu H, Xu H, Zhang N, Xu H, Li Z, Chen H, Xu R, Sun R, Wen L, Xie LJm: Association between Clinical, Laboratory and CT Characteristics and RT-PCR Results in the Follow-up of COVID-19 patients. 2020.
49. Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, Fan Y, Zheng CJTLID: Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. 2020.
50. Zhao W, Zhong Z, Xie X, Yu Q, Liu J: Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study. AJR American journal of roentgenology 2020:1-6.
51. Fan H, Zhang L, Huang B, Zhu M, Zhou Y, Zhang H, Tao X, Cheng S, Yu W, Zhu L: Retrospective Analysis of Clinical Features in 101 Death Cases with COVID-19.
52. Hu L, Chen S, Fu Y, Gao Z, Long H, Ren H-w, Zuo Y, Li H, Wang J, Xv Q-bJm: Risk Factors Associated with Clinical Outcomes in 323 COVID-19 Patients in Wuhan, China. 2020.
53. Zhao X, Liu B, Yu Y, Wang X, Du Y, Gu J, Wu XJCR: The characteristics and clinical value of chest CT images of novel coronavirus pneumonia. 2020.
54. Chen Z, Hu J, Zhang Z, Jiang S, Wang T, Shi Z, Zhang ZJm: Caution: The clinical characteristics of COVID-19 patients at admission are changing. 2020.
55. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, Li J, Zhao D, Xu D, Gong QJTL: Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. 2020, 395(10226):809-815.
56. Pung R, Chiew CJ, Young BE, Chin S, Chen MI, Clapham HE, Cook AR, Maurer-Stroh S, Toh MP, Poh CJTL: Investigation of three clusters of COVID-19 in Singapore: implications for surveillance and response measures. 2020.
57. Zhu W, Xie K, Lu H, Xu L, Zhou S, Fang SJJoMV: Initial clinical features of suspected Coronavirus Disease 2019 in two emergency departments outside of Hubei, China. 2020.
58. Chen X, Jiang Q, Ma Z, Ling J, Hu W, Cao Q, Mo P, Yang R, Gao S, Gui XJm: Clinical Characteristics of Hospitalized Patients with SARS-CoV-2 and Hepatitis B virus Co-infection. 2020.
59. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC et al: Clinical Characteristics of Coronavirus Disease 2019 in China. The New England journal of medicine 2020.
60. Xu X, Yu C, Qu J, Zhang L, Jiang S, Huang D, Chen B, Zhang Z, Guan W, Ling ZJEJoNM et al: Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. 2020:1-6.
61. Wu F, Zhao S, Yu B, Chen Y-M, Wang W, Song Z-G, Hu Y, Tao Z-W, Tian J-H, Pei Y-Y: A new coronavirus associated with human respiratory disease in China. Nature 2020, 579(7798):265-269.
62. worldometers []
63. Hu B, Zeng L-P, Yang X-L, Ge X-Y, Zhang W, Li B, Xie J-Z, Shen X-R, Zhang Y-Z, Wang NJPp: Discovery of a rich gene pool of bat SARS-related coronaviruses provides new insights into the origin of SARS coronavirus. 2017, 13(11).
64. Haagmans BL, Al Dhahiry SH, Reusken CB, Raj VS, Galiano M, Myers R, Godeke G-J, Jonges M, Farag E, Diab AJTLid: Middle East respiratory syndrome coronavirus in dromedary camels: an outbreak investigation. 2014, 14(2):140-145.
65. Peiris JSM, Chu C-M, Cheng VC-C, Chan K, Hung I, Poon LL, Law K-I, Tang B, Hon T, Chan CJTL: Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. 2003, 361(9371):1767-1772.
66. Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, Liu L, Shan H, Lei C-l, Hui DSJNEJoM: Clinical characteristics of coronavirus disease 2019 in China. 2020.
67. Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, Liu Y, Xiao J, Liu H, Deng D et al: Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. The Lancet Infectious diseases 2020.
68. Zumla A, Hui DS, Perlman SJTL: Middle East respiratory syndrome. 2015, 386(9997):995-1007.
69. Organization WH: Clinical management of severe acute respiratory infection when novel coronavirus (‎ 2019-nCoV)‎ infection is suspected: interim guidance, 28 January 2020. In.: World Health Organization; 2020.
70. Xu X, Chen P, Wang J, Feng J, Zhou H, Li X, Zhong W, Hao PJSCLS: Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. 2020, 63(3):457-460.
71. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, Wang MJJ: Presumed asymptomatic carrier transmission of COVID-19. 2020.
72. Zhang H, Kang Z, Gong H, Xu D, Wang J, Li Z, Cui X, Xiao J, Meng T, Zhou WJB: The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. 2020.