march 2020 • JCM
Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Reviewand Meta-Analysis
Primeira análise sistemática da evidência disponível até 24/02/2020, metodologicamente bem feita mas baseada em estudos de baixo grau de evidência (relatos de caso e séries de casos). Relembra os sintomas mais comuns, achados radiológicos característicos e o quanto ainda não se conhece da doença, alertando que a maioria das mortes ocorreu em pessoas com mais de 60 anos, nas quais o diagnóstico precoce podefazer a diferença. A suspeita clínica deve ser acompanhada de uma história epidemiológica relevante, seguida por exames virológicos e de imagem precoces. A maioria dos sintomas clínicos e achados imagiológicos são inespecíficos, sendo os mais comuns febre e tosse, opacidades em vidro fosco e consolidações. A mortalidade foi maior em doentes de sexo masculino e mais idosos.
A growing body of literature on the 2019 novel coronavirus (SARS-CoV-2) is becoming available, but a synthesis of available data has not been conducted. We performed a scoping review of currently available clinical, epidemiological, laboratory, and chest imaging data related to the SARS-CoV-2 infection. We searched MEDLINE, Cochrane CENTRAL, EMBASE, Scopus and LILACS from 01 January 2019 to 24 February 2020. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. Qualitative synthesis and meta-analysis were conducted using the clinical and laboratory data, and random-effects models were applied to estimate pooled results. A total of 61 studies were included (59,254 patients). The most common disease-related symptoms were fever (82%, 95% confidence interval (CI) 56%–99%; n = 4410), cough (61%, 95% CI 39%–81%; n = 3985), muscle aches and/or fatigue (36%, 95% CI 18%–55%; n = 3778), dyspnea (26%, 95% CI 12%–41%; n = 3700), headache in 12% (95% CI 4%–23%, n = 3598 patients), sore throat in 10% (95% CI 5%–17%, n = 1387) and gastrointestinal symptoms in 9% (95% CI 3%–17%, n = 1744). Laboratory findings were described in a lower number of patients and revealed lymphopenia (0.93 × 109/L, 95% CI 0.83–1.03 × 109/L, n = 464) and abnormal C-reactive protein (33.72 mg/dL, 95% CI 21.54–45.91 mg/dL; n = 1637). Radiological findings varied, but mostly described ground-glass opacities and consolidation. Data on treatment options were limited. All-cause mortality was 0.3% (95% CI 0.0%–1.0%; n = 53,631). Epidemiological studies showed that mortality was higher in males and elderly patients. The majority of reported clinical symptoms and laboratory findings related to SARS-CoV-2 infection are non-specific. Clinical suspicion, accompanied by a relevant epidemiological history, should be followed by early imaging and virological assay.