East-West Differences in Clinical Manifestations of COVID-19 Patients: A Systematic Literature Review and Meta-Analysis

Abstract

Background: The COVID-19 is currently not under control and has swept into over 200 countries with over 6 million cases and more than 370,000 deaths. We aimed to assess whether there are differences in clinical manifestations between COVID-19 patients from the East and the West. Methods: For this systematic review and meta-analysis, we searched for eligible studies about COVID-19 in three databases, PubMed, EMBASE, and Cochrane Library. The search results were updated in May 18, 2020. Studies were divided into two separate cohorts for analysis: the East (studies from the East and South-East Asia) and the West (studies from Europe, North America and West-Asia). Then, metaanalysis was performed by using Stata 13.1 software. Findings: Of 1527 studies identified by our literature search, 169 full-text articles were retrieved and screened for eligibility. Finally, 57 studies with 19353 patients were eligible for our inclusion. Of these, 45 studies with 8416 patients were from the East (China, South Korea, and Thailand). 12 studies with 10937 patients were from the West (United States, Italy, France, and Iran). The results indicated that the incidences of cough in COVID-19 patients from the East [0.62 versus 0.80, P=0.000], headache [0.10 versus 0.31, P=0.018], dizziness [0.07 versus 0.37, P=0.000], rhinobyon [0.06 versus 0.16, P=0.000], dyspnea [0.25 versus 0.66, P=0.000], sore throat [0.13 versus 0.20, P=0.030] and digestive symptoms [0.13 versus 0.50, P=0.035] were lower than those in the West. The laboratory data showed that there were no significant differences in the levels of lymphocyte [0.40 versus 0.48, P=0.716], leukocyte [0.08 versus 0.08, P=0.941], CRP [0.53 versus 0.71, P=0.110] and platelet [0.15 versus 0.18, P=0.418] between the two groups. In addition, our results also show that the incidences of cardiac injury [0.15 versus 0.37, P=0.055], kidney injury [0.06 versus 0.21, P=0.004] and the increase of creatinine, ALT [0.18 versus 0.39, P=0.000] and AST [0.19 versus 0.57, P=0.000] of patients from the West were significantly higher than those from the East. Interpretation: Our meta-analysis indicated that there are some differences in the clinical performances and mortality between COVID-19 patients from the East and the West. COVID-19 patients from the West appear to have suffered more severe liver, kidney and heart damage due to SRSA-CoV-2. Funding Statement: This work was supported by the Social Development Projects of Key R&D Programs in Jiangsu Province (BE2019643), the National Natural Science Foundation of Jiangsu Province (BK20171178), the General Program of Jiangsu Commission of Health (H2017083 ), the Project of Invigorating Health Care through Science, Technology and Education, Jiangsu Provincial Medical Youth Talent (QNRC2016778), the Foundation of Jiangsu Province Six Talents Peak (2015-WSN-063), the Xuzhou Medical Young Talents Project (2015 to H.Z.) and from Postgraduate Research & Practice Innovation Program of Jiangsu Province (KYCX18_2182). Declaration of Interests: The authors declare that they have no competing interests.