Clinical features, treatments and outcomes of severe and critical severe patients infected with COVID-19: A system review and meta-analysis

Backgrounds: : The outbreak of COVID-19 caused by a novel coronavirus, SARS-CoV-2, has been listed as a public health emergency of international concern by WHO. Most COVID-19 patients presented with a mild infection, but many challenges exist in therapy of severe and critical severe patients. This paper systematically reviewed clinical features, treatments and outcomes of severe and critical severe patients infected COVID-19. Methods: The clinical, laboratory, imaging features, treatment and outcomes of COVID-19 were collected. The data were analyzed by using STATA 15 statistical software to estimate the prevalence and 95% CI in severe and critical severe patients with COVID-19. A random or fixed effect model was used to estimate the prevalence and 95% CI. Results: After screening, 8 studies including a total of 275 patients were included in this meta-analysis. The percentage of severe and critical severe patients in confirmed COVID-19 cases was 25% (95% CI 16-36%). Fever, cough, dyspnea, lymphopenia and bilateral distribution of patchy shadows were the most prevalent findings in these patients. Utilization rate of antiviral drugs, corticosteroid, non-invasive ventilation, invasive mechanical ventilation was high in therapy strategies. The most prevalent complications were ARDS, shock, and acute cardiac injury. Discussion: Severe and critical severe COVID-19 patients usually had complications even a fatal outcome. As vaccines and anti-coronaviral drugs are under development, the principles of treatment for these patients should be focused on improving oxygenation, lung protective and function support of multiple organs.