Is loss of sense of smell as a diagnostic marker in COVID-19: A
Systematic Review and Meta-analysis
Abstract
Aims 1. To systematically review the currently available evidence
investigating the association between olfactory dysfunction (OD) and the
novel coronavirus (COVID-19). 2. To analyse the prevalence of OD in
patients who have tested positive on Polymerase Chain Reaction (PCR) for
COVID-19. 2. To perform a meta-analysis of patients presenting with
olfactory dysfunction, during the pandemic, and to investigate the
Positive Predictive Value for a COOVID-19 positive result in this
population. 3. To assess if olfactory dysfunction could be used as a
diagnostic marker for COVID-19 positivity and aid public health
approaches in tackling the current outbreak. Methods We systematically
searched MedLine (PubMed), Embase, Health Management Information
Consortium (HMIC), Medrxiv, the Cochrane Library, the Cochrane COVID-19
Study Register, NIHR Dissemination centre, Clinical Evidence, National
Health Service Evidence and the National Institute of Clinical
Excellence to identify the current published evidence which associates
coronaviridae or similar RNA viruses with anosmia. The initial search
identified 157 articles. 145 papers were excluded following application
of our exclusion criteria. The 12 remaining articles, that presented
evidence on the association between COVID-19 and olfactory dysfunction,
were critically analysed. Results OD has been shown to be the strongest
predictor of COVID-19 positivity when compared to other symptoms in
logistic regression analysis. In patients who had tested positive for
COVID-19 there was a prevalence of 62% of OD. In populations of
patients who are currently reporting OD there is a positive predictive
value of 61% for a positive COVID-19 result. Conclusion Our review has
shown that there is already significant evidence which demonstrates an
association between OD and the novel coronavirus – COVID-19. It is
unclear if this finding is unique to this coronavirus as individual
viral phenotypes rarely present in such concentrated large numbers. We
have demonstrated that OD is comparatively more predictive for COVID-19
positivity compared to other associated symptoms. We recommend that
people who develop OD during the pandemic should be self-isolate and
this guidance should be adopted internationally to prevent transmission.