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Received: 2020-06-07

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Journal of Zhejiang University SCIENCE B 2020 Vol.21 No.12 P.940-947


Factors associated with a SARS-CoV-2 recurrence after hospital discharge among patients with COVID-19: systematic review and meta-analysis

Author(s):  Meng-qi Yao, Qiu-xian Zheng, Jia Xu, Jing-wen Deng, Tian-tian Ge, Hai-bo Zhou, Feng-tian Wu, Xin-yu Gu, Qin Yang, Yan-li Ren, Gang Wang, Zhi Chen

Affiliation(s):  Zhejiang University School of Public Health, Hangzhou 310058, China; more

Corresponding email(s):   chenzhi@zju.edu.cn

Key Words:  Recurrence case, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Risk factor, Meta-analysis

Meng-qi Yao, Qiu-xian Zheng, Jia Xu, Jing-wen Deng, Tian-tian Ge, Hai-bo Zhou, Feng-tian Wu, Xin-yu Gu, Qin Yang, Yan-li Ren, Gang Wang, Zhi Chen. Factors associated with a SARS-CoV-2 recurrence after hospital discharge among patients with COVID-19: systematic review and meta-analysis[J]. Journal of Zhejiang University Science B, 2020, 21(12): 940-947.

@article{title="Factors associated with a SARS-CoV-2 recurrence after hospital discharge among patients with COVID-19: systematic review and meta-analysis",
author="Meng-qi Yao, Qiu-xian Zheng, Jia Xu, Jing-wen Deng, Tian-tian Ge, Hai-bo Zhou, Feng-tian Wu, Xin-yu Gu, Qin Yang, Yan-li Ren, Gang Wang, Zhi Chen",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Factors associated with a SARS-CoV-2 recurrence after hospital discharge among patients with COVID-19: systematic review and meta-analysis
%A Meng-qi Yao
%A Qiu-xian Zheng
%A Jia Xu
%A Jing-wen Deng
%A Tian-tian Ge
%A Hai-bo Zhou
%A Feng-tian Wu
%A Xin-yu Gu
%A Qin Yang
%A Yan-li Ren
%A Gang Wang
%A Zhi Chen
%J Journal of Zhejiang University SCIENCE B
%V 21
%N 12
%P 940-947
%@ 1673-1581
%D 2020
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B2000304

T1 - Factors associated with a SARS-CoV-2 recurrence after hospital discharge among patients with COVID-19: systematic review and meta-analysis
A1 - Meng-qi Yao
A1 - Qiu-xian Zheng
A1 - Jia Xu
A1 - Jing-wen Deng
A1 - Tian-tian Ge
A1 - Hai-bo Zhou
A1 - Feng-tian Wu
A1 - Xin-yu Gu
A1 - Qin Yang
A1 - Yan-li Ren
A1 - Gang Wang
A1 - Zhi Chen
J0 - Journal of Zhejiang University Science B
VL - 21
IS - 12
SP - 940
EP - 947
%@ 1673-1581
Y1 - 2020
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B2000304

Background: The proportion of recurrences after discharge among patients with coronavirus disease 2019 (COVID-19) was reported to be between 9.1% and 31.0%. Little is known about this issue, however, so we performed a meta-analysis to summarize the demographical, clinical, and laboratorial characteristics of non-recurrence and recurrence groups. Methods: Comprehensive searches were conducted using eight electronic databases. Data regarding the demographic, clinical, and laboratorial characteristics of both recurrence and non-recurrence groups were extracted, and quantitative and qualitative analyses were conducted. Results: Ten studies involving 2071 COVID-19 cases were included in this analysis. The proportion of recurrence cases involving patients with COVID-19 was 17.65% (between 12.38% and 25.16%) while older patients were more likely to experience recurrence (weighted mean difference (WMD)=1.67, range between 0.08 and 3.26). The time from discharge to recurrence was 13.38 d (between 12.08 and 14.69 d). Patients were categorized as having moderate severity (odds ratio (OR)=2.69, range between 1.30 and 5.58), while those with clinical symptoms including cough (OR=5.52, range between 3.18 and 9.60), sputum production (OR=5.10, range between 2.60 and 9.97), headache (OR=3.57, range between 1.36 and 9.35), and dizziness (OR=3.17, range between 1.12 and 8.96) were more likely to be associated with recurrence. Patients presenting with bilateral pulmonary infiltration and decreased leucocyte, platelet, and CD4+ T counts were at risk of COVID-19 recurrence (OR=1.71, range between 1.07 and 2.75; WMD=−1.06, range between −1.55 and −0.57, WMD=−40.39, range between −80.20 and −0.48, and WMD=−55.26, range between −105.92 and −4.60, respectively). Conclusions: The main factors associated with the recurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after hospital discharge were older age, moderate severity, bilateral pulmonary infiltration, laboratory findings including decreased leucocytes, platelets, and CD4+ T counts, and clinical symptoms including cough, sputum production, headache, and dizziness. These factors can be considered warning indicators for the recurrence of SARS-CoV-2 and might help the development of specific management strategies.


概要:通过检索筛选到10项涉及2071例新型冠状病毒肺炎(COVID-19)患者出院后复查严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)核酸检测的研究,总结其流行病学、临床症状和辅助检查特征.COVID-19患者出院后病毒检测复阳病例占比为17.65%,而年龄较大的患者更有可能病毒复阳,临床症状合并咳嗽、咳痰、头晕症状的患者有SARS-CoV-2复阳的风险.此外,辅助检查结果呈双侧肺浸润且白细胞、血小板和CD4+ T计数降低的患者有SARS-CoV-2病毒复阳的风险.这些因素可以被视为SARS-CoV-2复阳的预警指标,并可能有助于临床制定个体化管理策略.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


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[52]List of electronic supplementary materials

[53]Table S1 Search strategy of the recurrence cases with COVID-19

[54]Fig. S1 Forest plots of meta-analysis on the proportion of the asymptomatic individuals among the COVID-19 infections

[55]Fig. S2 Forest plots of meta-analysis on clinical characteristics and laboratory findings of the recurrence cases among the COVID-19 infections

[56]Fig. S3 Funnel plot assessing publication bias in studies reporting proportion of recurrence cases among the COVID-19 patients

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