Keywords
Case fatality Rate, COVID-19, Meta-Analysis, Epidemic, Epidemiology
Abstract
Objective: The ongoing novel coronavirus disease 2019 (COVID-19) is the main cause of morbidity and mortality due to its contagious nature and absence of vaccine and treatment. Although there are considerable primary studies that reported extremely variable case fatality rate (CFR) of COVID-19, there is no review study that attempted to estimate CFR of COVID-19. The current systematic review and meta-analysis was aimed to estimate the pooled CFR of COVID-19.
Methods: Electronic databases: PubMed, Science Direct, Scopus and Google Scholar were searched to retrieve the eligible primary studies that reported CFR of COVID-19. Keywords: ("COVID-19"OR "COVID-2019" OR "severe acute respiratory syndrome coronavirus 2"OR "severe acute respiratory syndrome coronavirus 2" OR "2019-nCoV" OR "SARS-CoV-2" OR "2019nCoV" OR (("Wuhan" AND ("coronavirus" OR "coronavirus")) AND (2019/12[PDAT] OR 2020[PDAT]))) AND ("mortality "OR "mortality" OR ("case" AND "fatality" AND "rate") OR "case fatality rate") were used as free text and MeSH term in searching process. Random-effects model used to estimate the CFR in this study. I2 statistic, Cochran’s Q test and T2 were used to assess the available heterogeneity between included studies.
Results: The overall pooled CFR of COVID 19 was 10.0 %( 95% CI: 8.0-11.0); P<0.001; I2 = 99.7). The pooled CFR of COVID 19 in general population was 1.0% (95% CI: 1.0–3.0); P<0.001; I2 = 94.3), while in hospitalized patients was 13.0 % (95% CI: 9.0–17.0); P<0.001, I2 = 95.6). The pooled CFR in patients admitted in intensive care unit (ICU) was 37.0 % (95% CI: 24.0–51.0); P<0.001, I2 = 97.8) and in patients older than 50 years was 19.0 % (95% CI: 13.0–24.0); P<0.001; I2 = 99.8).
Conclusion: The present review results highlighted the need of transparency in testing and reporting policies and denominators used in CFR estimation. It is also necessary reporting the cases age, sex and the comorbidity distribution of all patients which important in comparing the CFR among different segments of population.
References
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[2] Wu JT, Leung K, Bushman M, Kishore N, Niehus R, de Salazar PM, Cowling BJ, Lipsitch M, Leung GM: Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China. Nature medicine 2020:1-5.
[3] Sun P, Lu X, Xu C, Sun W, Pan B: Understanding of COVID‐19 based on current evidence. Journal of medical virology 2020.
[4] Yang S, Cao P, Du P, Wu Z, Zhuang Z, Yang L, Yu X, Zhou Q, Feng X, Wang X: Early estimation of the case fatality rate of COVID-19 in mainland China: a data-driven analysis. Annals of translational medicine 2020, 8(4).
[5] Shim E, Tariq A, Choi W, Lee Y, Chowell G: Transmission potential and severity of COVID-19 in South Korea. International Journal of Infectious Diseases 2020.
[6] Wallinga J, Teunis P: Different epidemic curves for severe acute respiratory syndrome reveal similar impacts of control measures. American Journal of epidemiology 2004, 160(6):509-516.
[7] Alimohamadi Y, Taghdir M, Sepandi M: The estimate of the basic reproduction number for novel coronavirus disease (covid-19): A systematic review and meta-analysis. Journal of Preventive Medicine and Public Health 2020.
[8] Onder G, Rezza G, Brusaferro S: Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. Jama 2020.
[9] Rajgor DD, Lee MH, Archuleta S, Bagdasarian N, Quek SC: The many estimates of the COVID-19 case fatality rate. The Lancet Infectious Diseases 2020.
[10] Russell TW, Hellewell J, Jarvis CI, Van Zandvoort K, Abbott S, Ratnayake R, Flasche S, Eggo RM, Edmunds WJ, Kucharski AJ: Estimating the infection and case fatality ratio for coronavirus disease (COVID-19) using age-adjusted data from the outbreak on the Diamond Princess cruise ship, February 2020. Eurosurveillance 2020, 25(12):2000256.
[11] Wells GA, Shea B, O’connell D, Peterson J, Welch V, Losos M, Tugwell P: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2013. In.; 2016.
[12] Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y et al: Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. Jama 2020.
[13] Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, Cereda D, Coluccello A, Foti G, Fumagalli R: Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. Jama 2020, 323(16):1574-1581.
[14] Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, Wang H, Wan J, Wang X, Lu Z: Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA cardiology 2020.
[15] Wang W, Tang J, Wei F: Updated understanding of the outbreak of 2019 novel coronavirus (2019‐nCoV) in Wuhan, China. Journal of medical virology 2020, 92(4):441-447.
[16] Tang N, Bai H, Chen X, Gong J, Li D, Sun Z: Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. Journal of thrombosis and haemostasis : JTH 2020.
[17] Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y: Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet 2020, 395(10223):507-513.
[18] Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M et al: Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory medicine 2020.
[19] 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.
[20] Barrasa H, Rello J, Tejada S, Martin A, Balziskueta G, Vinuesa C, Fernandez-Miret B, Villagra A, Vallejo A, Sebastian AS et al: SARS-Cov-2 in Spanish Intensive Care: Early Experience with 15-day Survival In Vitoria. Anaesthesia, critical care & pain medicine 2020.
[21] Tang X, Du R, Wang R, Cao T, Guan L, Yang C, Zhu Q, Hu M, Li X, Li Y et al: Comparison of Hospitalized Patients With ARDS Caused by COVID-19 and H1N1. Chest 2020.
[22] Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, Zhan LY, Jia Y, Zhang L, Liu D et al: Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine 2020:100331.
[23] Shim E, Tariq A, Choi W, Lee Y, Chowell G: Transmission potential and severity of COVID-19 in South Korea. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2020, 93:339-344.
[24] Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, Shi J, Zhou M, Wu B, Yang Z et al: Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. The Journal of allergy and clinical immunology 2020.
[25] Tian S, Hu N, Lou J, Chen K, Kang X, Xiang Z, Chen H, Wang D, Liu N, Liu D et al: Characteristics of COVID-19 infection in Beijing. The Journal of infection 2020, 80(4):401-406.
[26] Liu K, Chen Y, Lin R, Han K: Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. The Journal of infection 2020.
[27] Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, Luo M, Chen L, Zhao Y: Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. The Journal of infection 2020.
[28] Lei Z, Cao H, Jie Y, Huang Z, Guo X, Chen J, Peng L, Cao H, Dai X, Liu J et al: A cross-sectional comparison of epidemiological and clinical features of patients with coronavirus disease (COVID-19) in Wuhan and outside Wuhan, China. Travel medicine and infectious disease 2020:101664.
[29] Sun K, Chen J, Viboud C: Early epidemiological analysis of the 2019-nCoV outbreak based on a crowdsourced data. medRxiv 2020.
[30] Mei Y, Hu J: Preparedness is Essential for Western Pacific Islands during the COVID-19 Pandemic. Disaster medicine and public health preparedness 2020:1-11.
[31] Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, Ruan L, Song B, Cai Y, Wei M et al: A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. The New England journal of medicine 2020.
[32] Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, Greninger AL, Pipavath S, Wurfel MM, Evans L et al: Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. The New England journal of medicine 2020.
[33] Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A, Feldt T, Green G, Green ML, Lescure FX et al: Compassionate Use of Remdesivir for Patients with Severe Covid-19. The New England journal of medicine 2020.
[34] Liang WH, Guan WJ, Li CC, Li YM, Liang HR, Zhao Y, Liu XQ, Sang L, Chen RC, Tang CL et al: Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicenter) and outside Hubei (non-epicenter): A Nationwide Analysis of China. The European respiratory journal 2020.
[35] Gao L, Jiang D, Wen XS, Cheng XC, Sun M, He B, You LN, Lei P, Tan XW, Qin S et al: Prognostic value of NT-proBNP in patients with severe COVID-19. Respiratory research 2020, 21(1):83.
[36] Du RH, Liu LM, Yin W, Wang W, Guan LL, Yuan ML, Li YL, Hu Y, Li XY, Sun B et al: Hospitalization and Critical Care of 109 Decedents with COVID-19 Pneumonia in Wuhan, China. Annals of the American Thoracic Society 2020.
[37] Xu X-W, Wu X-X, Jiang X-G, Xu K-J, Ying L-J, Ma C-L, Li S-B, Wang H-Y, Zhang S, Gao H-N: Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ (Clinical research ed) 2020, 368.
[38] Cai Q, Huang D, Ou P, Yu H, Zhu Z, Xia Z, Su Y, Ma Z, Zhang Y, Li Z et al: COVID-19 in a Designated Infectious Diseases Hospital Outside Hubei Province, China. Allergy 2020.
[39] Cao J, Tu WJ, Cheng W, Yu L, Liu YK, Hu X, Liu Q: Clinical Features and Short-term Outcomes of 102 Patients with Corona Virus Disease 2019 in Wuhan, China. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2020.
[40] Liu K, Fang Y-Y, Deng Y, Liu W, Wang M-F, Ma J-P, Xiao W, Wang Y-N, Zhong M-H, Li C-H: Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chinese medical journal 2020.
[41] Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, Ng O-T, Marimuthu K, Ang LW, Mak TM: Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. Jama 2020, 323(15):1488-1494.
[42] Wang Z, Yang B, Li Q, Wen L, Zhang R: Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2020.
[43] McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, Lewis J, Baer A, Kawakami V, Lukoff MD et al: Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. The New England journal of medicine 2020.
[44] Liu Y, Sun W, Guo Y, Chen L, Zhang L, Zhao S, Long D, Yu L: Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study. Platelets 2020:1-7.
[45] Chen T, Dai Z, Mo P, Li X, Ma Z, Song S, Chen X, Luo M, Liang K, Gao S et al: Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. The journals of gerontology Series A, Biological sciences and medical sciences 2020.
[46] Tang N, Li D, Wang X, Sun Z: Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of thrombosis and haemostasis : JTH 2020, 18(4):844-847.
[47] Khafaie MA, Rahim F: Cross-country comparison of case fatality rates of COVID-19/SARS-COV-2. Osong public health and research perspectives 2020, 11(2):74.
[48] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X: Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet 2020, 395(10223):497-506.
[49] 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 DS: Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine 2020, 382(18):1708-1720.
[50] Khafaie MA, Rahim F: Cross-country comparison of case fatality rates of COVID-19/SARS-COV-2. Osong Public Health and Research Perspectives 2020, 11(2):74.
[51] COVID-19 Coronavirus Pandemic [https://www.worldometers.info/coronavirus/.]
[52] Singhal T: A review of coronavirus disease-2019 (COVID-19). The Indian Journal of Pediatrics 2020:1-6.
[53] Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, Greninger AL, Pipavath S, Wurfel MM, Evans L: Covid-19 in critically ill patients in the Seattle region—case series. New England Journal of Medicine 2020.
[54] Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, Lee M: Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. Jama 2020.
[55] Surveillances V: The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Weekly 2020, 2(8):113-122.
[56] He F, Deng Y, Li W: Coronavirus disease 2019: What we know? Journal of medical virology 2020.
[57] Mojadam M, Matlabi M, Haji A, Cheraghi M, Bitaraf S, Khafaie MA: Khuzestan dust phenomenon: a content analysis of most widely circulated newspapers. Environmental Science and Pollution Research 2018, 25(16):15918-15924.