Association Between Symptoms and Severity of Disease in Hospitalised Novel Coronavirus (COVID-19) Patients: A Systematic Review and Meta-Analysis

Ashis Talukder,1 Shaharior Rahman Razu,2 Sheikh Mohammad Alif,3 Muhammad Aziz Rahman,4,5 Sheikh Mohammed Shariful Islam6 1Statistics Discipline, Khulna University, Khulna, 9208, Bangladesh; 2Sociology Discipline, Khulna University, Khulna, 9208, Bangladesh; 3School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; 4Institute of Health and Wellbeing, Federation University Australia, Berwick, Australia; 5Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia; 6Institute for Physical Activity and Nutrition, Deakin University, Melbourne, AustraliaCorrespondence: Ashis Talukder, Statistics Discipline, Khulna University, Khulna, 9208, Bangladesh, Tel +8801772063507, Email ashistalukder3168@ku.ac.bd Muhammad Aziz Rahman, Institute of Health and Wellbeing, Federation University Australia, Berwick, Australia, Tel +61343137908, Email ma.rahman@federation.edu.auBackground: 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 disease severity. We aimed to evaluate the association between symptoms and severity of disease in adult patients with confirmed COVID-19 by performing a meta-analysis.Methods: We conducted this study 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 January 1, 2020, and October 31, 2021. PRISMA and MOOSE guidelines were followed, and only articles published in English were selected. We performed meta-analysis using Mantel-Haenszel random-effects model. Note that we included peer-reviewed studies conducted in Wuhan and published in the English language that reported the clinical characteristics of COVID-19, particularly the symptoms of novel coronavirus patients with their prevalence and distribution of patients based on the severity of the disease.Results: Out of 255 articles identified, a total of twenty articles, including 5390 participants, met the inclusion criteria and were included. Among the participants, 2997 (55.60%) were males, and 974 (18.07%) reported severe conditions. Fever was the most commonly reported symptom in the reported COVID-19 confirmed cases (88.47%, 95% CI: 80.74– 93.35%), which was followed by cough, fatigue, and less proportionally dyspnea and myalgia. Dyspnea was the only symptom, which was associated with severity of COVID-19 (OR 2.43, 95% CI: 1.52– 3.89).Conclusion: 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.Keywords: coronavirus, COVID-19, symptoms, respiratory, severity