Prolonged Symptom Onset to Admission Time Is Associated with Severe Coronavirus Disease: A Meta-Analysis and Single-Center Retrospective Study

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 has caused a worldwide pandemic since late 2019. Strict policies for timely isolation and treatment can help reduce the spread of coronavirus disease 2019 (COVID-19).We aimed to investigate whether a shorter symptom onset to admission time could improve outcomes of COVID-19 patients and provide an effective strategy for COVID-19 control.Methods: A systematic review and meta-analysis were performed to identify studies published between December 1, 2019 and April 15, 2020. Additionally, clinical data of COVID-19 patients diagnosed between January 20 and February 20, 2020 at the First Affiliated Hospital of the University of Science and Technology of China were retrospectively analyzed. The symptom onset to admission time and severity of illness in patients with COVID-19 were used as effect measures. Propensity score matching was applied to adjust for confounding factors in the retrospective study. The random effects model was used to analyze the heterogeneity across studies. Categorical data were compared using the Fisher’s exact test. We compared the differences in laboratory characteristic vary times using a two-way nonparametric, Scheirer-Ray-Hare test. P Findings: Eleven studies including 2503 cases were finally enrolled in this meta-analysis. Among which, 500 cases were combined with adverse outcomes: 245 deaths, 36 intensive care unit admissions, and 219 with severe disease. Patients with adverse outcomes had a longer symptom onset to admission time (I 2 =39%, mean difference=0·88, 95% confidence interval=0·47–1·30).Interpretation: Shortening the symptom onset to admission time may help reduce the possibility of mild patients with COVID-19 progressing to severe illness.Funding Statement: The study was funded by the Natural Science Foundation Project of Guangdong Province, China, (No.2018A030313618), and the Postdoctoral Science Foundation of China (Grant No. 2019M663260 & 2020T130148ZX).Declaration of Interests: All authors declare that they have no conflicts of interest.Ethics Approval Statement: This study was approved by the Research Ethics Commission of the First Affiliated Hospital of the University of Science and Technology of China (approval no. 2020-P-018). The requirement for informed consent was waived because it was a retrospective study, and the patients could not be identified.