Early clinical characteristics of Covid-19: scoping review-猫眼课题宝

DOI：

10.1101/2020.07.31.20165738

发表时间：

2020-08

期刊：

medRxiv

影响因子：

通讯作者：

中科院分区：

其他

文献类型：

作者：

Lakshmi Manoharan;J. W. S. Cattrall;C. Harris;K. Newell;B. Thomson;M. Pritchard;P. Bannister;Tommy Solomon;P. Horby;L. Sigfrid;G. Carson;P. Olliaro

摘要背景：2019 年冠状病毒病（covid-19）大流行已在全球迅速蔓延。准确的临床特征研究对于为研究、诊断和临床管理工作提供信息至关重要，特别是在大流行的早期。在这次范围界定审查中，我们确定了大流行最初几个月入院患者的临床特征，重点关注症状、实验室和影像学结果以及临床结果。方法：范围界定审查。 MEDLINE、EMBASE 和 Global Health 数据库检索了 2020 年 1 月 1 日至 2020 年 4 月 28 日发表的研究。其中包括报告至少 100 名任何年龄的 covid-19 住院患者的研究。结果：在通过检索确定的 1,249 项研究中，有 78 项研究符合纳入条件；一项随机对照试验和 77 项观察性研究提供了 77,443 名 covid-19 患者的数据。大多数研究是在中国进行的（82%），9%在美国，10%在欧洲，还有两项研究在多个国家进行。没有研究包括来自低收入和中等收入国家的患者。在大流行的最初几个月，凝血障碍作为一种并发症并未得到充分认识。皮质类固醇的使用差异很大，并且仅在一项研究中报告了抗凝剂的使用。发烧、咳嗽和呼吸困难在老年人中较少见；胃肠道症状作为唯一的表现特征可能未被充分认识。最常见的实验室检查结果是淋巴细胞减少。炎症生物标志物普遍升高，包括 C 反应蛋白和白细胞介素 6。典型的计算机断层扫描结果包括双侧浸润，但早期疾病的成像可能正常。有关儿童和弱势群体临床特征的数据有限。结论：大流行早期的临床特征研究表明，covid-19 是一种多系统疾病，其生物标志物表明炎症和凝血病。然而，关于症状和临床结果的早期数据收集并没有一致地反映这一广泛的范围。皮质类固醇的使用差异很大，并且很少使用抗凝剂。临床医生应对没有发烧、咳嗽和呼吸困难的患者（尤其是老年人）感染 covid-19 的可能性保持警惕。需要对不同的高危人群进行进一步的特征研究。审查注册：可在 https://osf.io/r2ch9 获取关键词：Covid-19、临床特征、症状、生化参数、影像学、结果、流行病研究

ABSTRACT Background: The Coronavirus disease 2019 (covid-19) pandemic has spread rapidly across the globe. Accurate clinical characterisation studies are essential to informing research, diagnosis and clinical management efforts, particularly early in a pandemic. In this scoping review we identify the clinical characteristics of patients admitted to hospital in the early months of the pandemic, focusing on symptoms, laboratory and imaging findings, and clinical outcomes. Methods: A scoping review. MEDLINE, EMBASE and Global Health databases were searched studies published from January 1st 2020 to April 28th 2020. Studies which reported on at least 100 hospitalised patients with covid-19 of any age were included. Results: Of 1,249 studies identified through the search 78 studies were eligible for inclusion; one randomized control trial and 77 observational studies presenting data on 77,443 patients admitted with covid-19. Most studies were conducted in China (82%), 9% in the US and 10% in Europe and two studies were set in more than one country. No studies included patients from low and middle income countries. Coagulopathy was underrecognised as a complication in the early months of the pandemic. Use of corticosteroids varied widely, and the use of anticoagulants was reported in only one study. Fever, cough and dyspnoea are less common in older adults; gastrointestinal symptoms, as the only presenting feature may be underrecognised. The most common laboratory finding was lymphocytopenia. Inflammatory biomarkers were commonly elevated, including C-reactive protein and interleukin-6. Typical computed tomography findings include bilateral infiltrates however imaging may be normal in early disease. Data on clinical characteristics in children and vulnerable populations were limited. Conclusions: Clinical characterisation studies from early in the pandemic indicated that covid-19 is a multisystem disease, with biomarkers indicating inflammation and coagulopathy. However, early data collection on symptoms and clinical outcomes did not consistently reflect this wide spectrum. Corticosteroid use varied widely, and anticoagulants were rarely used. Clinicians should remain vigilant to the possibility of covid-19 in patients presenting without fever, cough and dyspnoea, particularly in older adults. Further characterisation studies in different at-risk populations is needed. Review registration: Available at https://osf.io/r2ch9 Keywords: Covid-19, clinical characteristics, symptoms, biochemical parameters, imaging, outcomes, pandemic research

Early clinical characteristics of Covid-19: scoping review

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