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Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews.
BMC Infect Dis. 2021 Jun 04; 21(1):525.BI

Abstract

BACKGROUND

Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

METHODS

Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO's Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes.

RESULTS

Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as "critically low". Identified symptoms of COVID-19 were (range values of point estimates): fever (82-95%), cough with or without sputum (58-72%), dyspnea (26-59%), myalgia or muscle fatigue (29-51%), sore throat (10-13%), headache (8-12%) and gastrointestinal complaints (5-9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%.

CONCLUSIONS

In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was "critically low". Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.

Authors+Show Affiliations

University Hospital and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. Medical College of Wisconsin, Milwaukee, WI, USA.Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, OH, USA. School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland.Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany.Department of Sport and Health Science, Technische Universität München, Munich, Germany.School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia. Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.Cochrane Croatia, University of Split, School of Medicine, Split, Croatia.Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, 10000, Zagreb, Croatia. livia.puljak@gmail.com.Cochrane Brazil, Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, Brazil.Cochrane Croatia, University of Split, School of Medicine, Split, Croatia.Cochrane Croatia, University of Split, School of Medicine, Split, Croatia.Cochrane Brazil, Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, Brazil.Yorkville University, Fredericton, New Brunswick, Canada.Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada.University Hospital and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.No affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

34088271

Citation

Borges do Nascimento, Israel Júnior, et al. "Coronavirus Disease (COVID-19) Pandemic: an Overview of Systematic Reviews." BMC Infectious Diseases, vol. 21, no. 1, 2021, p. 525.
Borges do Nascimento IJ, O'Mathúna DP, von Groote TC, et al. Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews. BMC Infect Dis. 2021;21(1):525.
Borges do Nascimento, I. J., O'Mathúna, D. P., von Groote, T. C., Abdulazeem, H. M., Weerasekara, I., Marusic, A., Puljak, L., Civile, V. T., Zakarija-Grkovic, I., Pericic, T. P., Atallah, A. N., Filoso, S., Bragazzi, N. L., & Marcolino, M. S. (2021). Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews. BMC Infectious Diseases, 21(1), 525. https://doi.org/10.1186/s12879-021-06214-4
Borges do Nascimento IJ, et al. Coronavirus Disease (COVID-19) Pandemic: an Overview of Systematic Reviews. BMC Infect Dis. 2021 Jun 4;21(1):525. PubMed PMID: 34088271.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews. AU - Borges do Nascimento,Israel Júnior, AU - O'Mathúna,Dónal P, AU - von Groote,Thilo Caspar, AU - Abdulazeem,Hebatullah Mohamed, AU - Weerasekara,Ishanka, AU - Marusic,Ana, AU - Puljak,Livia, AU - Civile,Vinicius Tassoni, AU - Zakarija-Grkovic,Irena, AU - Pericic,Tina Poklepovic, AU - Atallah,Alvaro Nagib, AU - Filoso,Santino, AU - Bragazzi,Nicola Luigi, AU - Marcolino,Milena Soriano, AU - ,, Y1 - 2021/06/04/ PY - 2020/04/12/received PY - 2021/05/19/accepted PY - 2021/6/5/entrez PY - 2021/6/6/pubmed PY - 2021/6/11/medline KW - COVID-19 KW - Coronavirus KW - Evidence-based medicine KW - Infectious diseases KW - SARS-Cov-2 SP - 525 EP - 525 JF - BMC infectious diseases JO - BMC Infect Dis VL - 21 IS - 1 N2 - BACKGROUND: Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic. METHODS: Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO's Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes. RESULTS: Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as "critically low". Identified symptoms of COVID-19 were (range values of point estimates): fever (82-95%), cough with or without sputum (58-72%), dyspnea (26-59%), myalgia or muscle fatigue (29-51%), sore throat (10-13%), headache (8-12%) and gastrointestinal complaints (5-9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%. CONCLUSIONS: In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was "critically low". Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/34088271/Coronavirus_disease__COVID_19__pandemic:_an_overview_of_systematic_reviews_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06214-4 DB - PRIME DP - Unbound Medicine ER -