The top 50 most-cited articles about COVID-19 and the complications of COVID-19: A bibliometric analysis

Background This bibliometric analysis examines the top 50 most-cited articles on COVID-19 complications, offering insights into the multifaceted impact of the virus. Since its emergence in Wuhan in December 2019, COVID-19 has evolved into a global health crisis, with over 770 million confirmed cases and 6.9 million deaths as of September 2023. Initially recognized as a respiratory illness causing pneumonia and ARDS, its diverse complications extend to cardiovascular, gastrointestinal, renal, hematological, neurological, endocrinological, ophthalmological, hepatobiliary, and dermatological systems. Methods Identifying the top 50 articles from a pool of 5940 in Scopus, the analysis spans November 2019 to July 2021, employing terms related to COVID-19 and complications. Rigorous review criteria excluded non-relevant studies, basic science research, and animal models. The authors independently reviewed articles, considering factors like title, citations, publication year, journal, impact factor, authors, study details, and patient demographics. Results The focus is primarily on 2020 publications (96%), with all articles being open access. Leading journals include The Lancet, NEJM, and JAMA, with prominent contributions from Internal Medicine (46.9%) and Pulmonary Medicine (14.5%). China played a major role (34.9%), followed by France and Belgium. Clinical features were the primary study topic (68%), often utilizing retrospective designs (24%). Among 22,477 patients analyzed, 54.8% were male, with the most common age group being 26-65 years (63.2%). Complications of COVID-19 affected 13.9% of patients, with a recovery rate of 57.8%. Conclusion Analyzing these top-cited articles offers clinicians and researchers a comprehensive, timely understanding of influential COVID-19 literature. This approach uncovers attributes contributing to high citations and provides authors with valuable insights for crafting impactful research. As a strategic tool, this analysis facilitates staying updated and making meaningful contributions to the dynamic field of COVID-19 research.


Introduction
In December 2019, the first outbreak of Coronavirus disease (COVID- 19) was detected in Wuhan. 1 On 30 th January 2020, the World Health Organization (WHO) declared COVID-19 outbreak as a "public health emergency of international concern" and on 11 th March 2020, COVID-19 was declared a pandemic by the WHO. 2 As of September 2023, the coronavirus SARS-COV-2 (severe acute respiratory syndrome coronavirus-2) is responsible for a total of 770 million confirmed cases and 6.9 million confirmed deaths.With the start of COVID-19 vaccination, a total of 3 billion vaccine doses have been administered as per WHO. 3 While, SARS-COV-2 is primarily considered as a respiratory disease known to cause pneumonia and acute respiratory distress syndrome (ARDS), there have been numerous reports about its many extra pulmonary manifestations.Literature suggests that the cardiovascular, gastrointestinal, renal, haematological, neurologic, endocrinologic, ophthalmologic, hepatobiliary and dermatologic systems can all be affected. 4This can result either due to the extrapulmonary dissemination and replication of the SARS-COV-2 or due to the widespread immunopathological sequelae of the disease. 5bliometric analysis is the application of statistical methods to evaluate the impact of a manuscript, research performance, author contribution to a particular field and to quantitatively analyse the most influential articles related to a particular field. 6cording to our literature search, no current bibliometric analysis has focused on COVID-19 complications.The purpose of this bibliometric analysis was to compile and analyse the top 50 most-cited articles regarding COVID-19 complications across all peer-reviewed scientific journals.

REVISED Amendments from Version 2
In Version 2 of this article, we have expanded our discussion on the treatments available for COVID-19, particularly focusing on antivirals and steroids.Additionally, this revised version delves into the pathology behind the most common complications of COVID-19.The article's conclusion has been restructured to better highlight the complications of COVID-19.
A total of 5940 articles were accessed, of which the top 50 most cited articles about COVID-19 and Complications of COVID-19 were selected through Scopus.Each article was reviewed for its appropriateness for inclusion.The articles were independently reviewed by three researchers (JRP, MAM and TS) (Table 1).Differences in opinion with regards to article inclusion was resolved by consensus.

Year of publication
Of the total 50 articles that were analyzed, 48 (96%) articles were published in the year 2020, while 1 (2%) article was published in 2021 and 1 (2%) article was published in the year 2003 (Table 2).

Open access
All of the 50 (100%) articles analyzed in the bibliometric study were open access articles.

Journals
Of the total 50 articles that were analyzed, the journals that published the most number of articles published were in the The Lancet (9), NEJM (7) and JAMA (4), while Eurosurveillance, Transitional Research and Annals of Internal Medicine published one each (Table 3).

Authors
Among the 50 articles that were analyzed, the most frequently cited authors contributed 4 articles each to the list (Table 4).

Departmental affiliations
Among the top 50 most-cited articles, the departmental affiliations were primarily in Internal Medicine (46.9%),Pulmonary Medicine (14.5%), and Bioscience and Technology (12.1%).Conversely, the Departments of Immunology, Paediatrics, and Urology had the lowest representation (Table 5).

Country of origin
In the research analyzed within the top 50 COVID-19 articles, a total of 83 countries participated.Notably, China played a substantial role, contributing to 29 articles (34.9%).France and Belgium closely followed; each being involved in 10 articles (12.1%).Additional contributing nations included Canada with 3 articles (3.6%), the UK with 2 articles (2.4%), and Switzerland with 1 article (1.2%) (Table 6).Study topic Among the 50 most-cited articles examined in this analysis, the predominant research themes were clinical features, comprising 34 articles (68%).Following closely were articles related to drug trials and interactions, accounting for 6 articles (12%).Additionally, there were 3 articles (6%) dedicated to analytical studies.Mortality studies constituted 2 articles (4%), while a single article each (2%) delved into the psychological impact and molecular mechanisms of COVID-19 (Table 7).

Patient statistics/demographics
A total of 22477 patients were analyzed from the top 50 most-cited articles.

Age distribution
The most common age group among the patients was 26-65 years of age with 14255 (63.2%) patients, followed by the age of 65 years with 6018 (26.8%) patients and then 12-25 years with 2204 (9.8%) patients (Table 10).

Clinical features
Among the 22477 patients, the most common clinical features were fever in 6333 (   13).The Lancet published the greatest number of articles from the top 50 most-cited list with a total of 9 articles, followed by NEJM with 7 articles and JAMA with 4 articles published respectively.Most of the articles (n=48, 96%) were published in the year 2020 with China (n=29, 34.9%), France (n=10, 12.1%) and Belgium (n=10,12.1%)being the top contributing countries.
In this bibliometric analysis, we found that 54.8% of the total patients were males while 45.2% were female patients.
In an article written by Bwire, it was reported that females were more resistant to Covid-19 infection.This could be attributed to various factors such as sex hormones, higher expression of ACE-2 receptors in men and also difference in the lifestyles. 57e incidence of COVID-19 infection was highest in adults between 26-65 years (63.2%),followed by the adults over 65 years of age (26.8%), and least in 12-25 years age group (9.8%).Though it is evident that the older population were more at risk for hospitalizations and deaths due to COVID-19, researchers have not been able to pinpoint a particular reason for the same.The current hypothesis is that this could be as a result of changes to the immune cell repertoire, the epigenome, NAD+ levels, inflammasome activity, biological clocks, and covalent modifications of human and viral proteins. 22In addition to this, it is not really understood why SARS-CoV-2 damages such a broad array of tissues in older people. 22milar findings were reported in a study conducted by Jakhmola S et al, with the highest incidence of Covid-19 infection in the age groups of 20-49 years and above 50 years, and the least in the paediatric age group.This could possibly be due to lesser expression of the coronavirus (ACE-2) receptors in the nasal epithelium in younger age groups, leading to reduced susceptibility to Covid 19 infection. 58Centers for Disease Control and Prevention (CDC) reported the highest incidence of COVID-19 infection among adults above the age of 80 years and in the age group of 18-24 years during 2020. 59 our analysis, the most common clinical features were fever (28.2%), tachycardia (17.9%) and dry cough (13.8%).
Other common features included impaired sense of smell (1.8%), impaired taste sensation (1.8%) and headache (1.5%).Similar to the above-mentioned findings, a study by Cascella M et al, reported the most common symptoms in patients to be fever, dry cough and dyspnoea.Other lesser common symptoms included malaise and headache. 60In a study by Mullol J et al., it was concluded that most viral respiratory infections such as COVID-19 are associated with impairment of sense of smell.The incidence of olfactory and gustatory symptoms varies due to the varied methodology used in various studies. 61In addition to this, it is also worth noting that recent studies about COVID-19 have identified possible long-term effects as a result of COVID-19 such as memory loss, difficulty concentrating, disturbances in sleep, and mild irreversible multi organ damage.Of the total patients analysed in our study, 97.8% patients were found to have comorbidities.Of which, hypertension (30.6%), diabetes mellitus (23.1%) and obesity (12.1%) were the commonest comorbidities found in the patients.
Other comorbidities included chronic liver disease (0.34%), endocrine disorders (0.24%) and psychiatric disorders (0.06%).In a study by Sanyaolu et al, that the common comorbidities found were hypertension, diabetes mellitus and obesity, which were associated with poorer outcomes in COVID-19 patients. 62 all the patients analysed in our study, 13.9% of patients developed complications following COVID-19 infection.The common complications seen among the patients were acute kidney injury (22.5%),ARDS (18.3%) and sepsis (11.0%).
Other complications included thrombosis (3.6%), acute hepatic injury (2.4%) and arrhythmias (2.0%).In the study by Cascella M et al, it was reported that ARDS was the most common pulmonary complication of COVID-19 while extrapulmonary complications included AKI, cardiovascular complications and prothrombotic complications. 60Similarly, in another study by Isath A et al., the most common complications reported were respiratory failure, AKI, sepsis and thrombosis. 63ARDS due to COVID-19 usually represents a specific sub type in which the hypoxia occurs as a result of coexistence of non-aerated regions and large areas of low ventilation-perfusion ratio. 16Additionally, the excessive inflammatory reactions that occur during COVID-19 can damage the lung cells which then disrupt the alveolar-capillary barrier which is crucial for gas exchange. 16Acute kidney injury occurring as a complication in patients with COVID-19 are thought to occur as a result of multiple factors interplaying with each other.This could arise as a result of the direct effects of the virus, cardiovascular morbidity, activation of coagulation pathways, endothelial injury or activation of the renin-angiotensin pathways.Patients with sepsis could develop AKI as a result of the cytopathic effects of SARS-COV-2 on the podocytes and proximal tubule cells. 60In addition to this, the presence of viral particles in renal endothelial cells may also cause endothelial damage which in turn promotes a state of hypercoagulability, and macrophage activation leading to formation of microthrombi and renal microvasculature injury. 60 our analysis, 57.8% patients recovered without any complications, while 31.1% were hospitalised, and 11.1% deceased due to the illness.Similar findings were reported in a study by Isath A et al., where 51.4% patients recovered and were discharged home, and the overall inpatient mortality was reported to be 13.2%.Most of the patients with comorbidities were associated with higher number of complications and mortality. 63ring the early days of COVID-19, remdesivir was a popular treatment in the course of a COVID-19 infection.However, in a study held by Wang Y, it was found that the use of remdesivir did not significantly change the time to clinical improvement compared to placebo.In the subgroup of patients who had symptoms for 10 days or less, those treated with remdesivir showed a non-statistically significant, yet faster improvement. 33Adverse events were slightly more common in the remdesivir group, affecting 66% of its recipients, compared to 64% in the placebo group. 33In a study held among critically ill patients, it was found that patients had a shorter duration of mechanical ventilation when treated with oseltamivir. 64Additionally, in the same study it was also found that there was no significant difference in the hospital mortality rates of these patients. 64As per current guidelines, the United States National Institute of Health (NIH) recommends against the use of systemic corticosteroid therapy for patients with mild to moderate COVID-19 infection and in those patients that do not require supplemental oxygen therapy. 65It was found that systemic corticosteroid therapy is only beneficial when used in patients who require supplement oxygen therapy (conventional oxygen, high flow nasal cannula oxygen, non-invasive ventilation, mechanical ventilation or extracorporeal membrane oxygenation). 65,66lthough there was a widespread use of corticosteroids during the early days of COVID-19, 66 the NIH has now recommended against the use of it in mild or moderate cases. 65In another study, the authors researched the benefit of using anticoagulants as a treatment for COVID-19.The authors found that there was no significant difference in 28-day mortality rates between patients treated with heparin and those who were not.However, among patients with a SIC score of 4 or higher, or with D-dimer levels more than six times the upper limit of normal, those who received heparin had significantly lower 28-day mortality rates compared to those who did not receive heparin. 34e authors of the studies have recommended and stated that vaccination campaigns have been pivotal.Empirical studies demonstrate a marked reduction in infection rates, severity of clinical manifestations, and mortality associated with COVID-19 following the administration of authorized vaccines.These biological agents not only confer individual protection but also contribute to herd immunity, thereby attenuating community-level transmission. 21reover, mechanical barriers such as facial masks have emerged as critical in impeding viral dissemination.
A consensus in the scientific community advocates for the utilization of higher filtration efficiency respirators (e.g., N95, KN95) in public settings, especially where physical distancing cannot be maintained and in poorly ventilated indoor environments. 22s a limitation of the present study, it is important to note that the analysis does not delve into network visualizations among authors or collaborative research endeavors involving multiple institutions and countries.These aspects are beyond the scope of the bibliometric analysis conducted in this research.Furthermore, the authors did not utilize specialized analysis tools such as VOS viewer or Biblioshiny.Additionally, the validation of article contents was performed manually by individual authors and recorded in a data sheet. 67

Conclusion
This article offers a quick overview of the most influential literature and how COVID-19 research has evolved over time.This insight can be instrumental for authors, offering guidance on creating impactful research in the future.In conclusion, as evidenced by the analysis of the 50 most-cited articles on COVID-19 and its complications, it is apparent that understanding the most common symptoms such as fever, tachycardia, and dry cough is crucial for both clinicians and researchers.In this analysis, it was found that the most common complications found in patients with COVID-19 were acute kidney injury (AKI) and acute respiratory distress syndrome.The occurrence of AKI can be explained as a result of the direct effects of the virus or as a result of activation of multiple physiologic pathways which eventually lead to renal microvascular injury.ARDS can occur as a result of the excessive inflammatory reactions during the infection leading to a disruption of the alveolar-capillary barrier thereby affecting the individuals gas exchange.With China leading in publications on the subject and The Lancet emerging as the primary journal for disseminating COVID-19 research, it is clear that the global scientific community has mobilized to address this pressing issue.Moreover, recognizing prevalent comorbidities like hypertension (HTN) and diabetes underscores the need for comprehensive management strategies.By leveraging insights from these influential publications, researchers can navigate the complex landscape of COVID-19 research effectively, ultimately contributing to our collective efforts to combat this pandemic.Overall, this method serves as a strategic tool for staying updated and contributing meaningfully to the field of COVID-19 research.adequately supported by the results, reflecting a clear understanding of the factors contributing to the citation impact of COVID-19 research.The discussion around the predominance of studies from certain countries and fields provides valuable insights.
Constructive Feedback: The authors might consider expanding their conclusions to reflect on how these citation patterns could influence future research priorities and the potential biases in the current COVID-19 literature.

Are sufficient details of methods and analysis provided to allow replication by others? Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Not applicable
Are all the source data underlying the results available to ensure full reproducibility?Partly

Are the conclusions drawn adequately supported by the results? Yes
Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Strengths：
Comprehensive Review: The study effectively identifies and analyzes the top 50 most-cited articles on COVID-19 complications, providing valuable insights into the most influential research in this field.Methodological Rigor: The use of Scopus as a data source and the detailed criteria for article selection and evaluation ensure a high level of methodological rigor.Detailed Analysis: The study provides extensive data on various aspects of the articles, including publication year, journal impact, geographical distribution, and study focus, offering a thorough overview of the research landscape.Clinical Relevance: By focusing on complications and clinical features, the study provides information that is directly relevant to healthcare professionals dealing with COVID-19 patients.
Recommendations： Expand the Time Frame: The study focuses on articles published up to July 2021.Extending the analysis to include more recent publications would provide a more current view of influential research.IncludeMore Databases: Incorporating other databases like PubMed and Web of Science could offer a broader scope and capture additional influential articles not indexed in Scopus.Deeper Analysis of Complications: A more detailed analysis of specific complications and their management could enhance the practical utility of the study for clinicians.Visualization Tools: Utilizing visual tools like graphs and charts to represent data on citations, geographical distribution, and study focus could make the findings more accessible and easier to interpret.Addressing Bias: Discuss potential biases, such as the overrepresentation of certain countries or journals, and suggest ways to mitigate these in future research.
Limitations： Publication Bias: The study may be influenced by publication bias, where more prominent journals and articles with positive findings are more likely to be cited.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.
Reviewer Report 14 August 2024 https://doi.org/10.5256/f1000research.165741.r290243

Husnul Khuluq
Universitas Muhammadiyah Gombong, Kebumen, Indonesia The third revision of the document is substantially complete; however, it lacks a crucial element in the conclusion section, specifically concerning recommendations for future research.

If applicable, is the statistical analysis and its interpretation appropriate? Yes
Are all the source data underlying the results available to ensure full reproducibility?Yes

Are the conclusions drawn adequately supported by the results? Yes
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: bibliometric , big data , machine learning, clinical pharmacy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Husnul Khuluq
Universitas Muhammadiyah Gombong, Kebumen, Indonesia 1.In the discussion session, the utilization of remdesivir and anticoagulants for therapy was addressed.However, this topic was not supported by bibliometric analysis data, unlike other discussed variables such as comorbidities, age, gender, clinical symptoms, complications, and outcomes.On the other hand, several other antiviral agents such as oseltamivir and favipiravir have not been discussed.Furthermore, the use of other drug classes, including corticosteroids, HCQ (Hydroxychloroquine), and antibiotics, which significantly influence therapy outcomes, was also not covered.This omission highlights a gap in the comprehensive evaluation of therapeutic strategies.2. In the conclusion, it would be advisable for the authors to concentrate more closely on the designated topic of the paper, which is complications.This focus would enhance the relevance and coherence of the findings in relation to the stated objectives of the research.

If applicable, is the statistical analysis and its interpretation appropriate? Yes
Are all the source data underlying the results available to ensure full reproducibility?Yes

Are the conclusions drawn adequately supported by the results? Yes
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: bibliometric , big data , machine learning, clinical pharmacy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
Q1.In the discussion session, the utilization of remdesivir and anticoagulants for therapy was addressed.However, this topic was not supported by bibliometric analysis data, unlike other discussed variables such as comorbidities, age, gender, clinical symptoms, complications, and outcomes.On the other hand, several other antiviral agents such as oseltamivir and favipiravir have not been discussed.Furthermore, the use of other drug classes, including corticosteroids, HCQ (Hydroxychloroquine), and antibiotics, which significantly influence therapy outcomes, was also not covered.This omission highlights a gap in the comprehensive evaluation of therapeutic strategies A1.Thank you for the comment.In the current version of the article, we have discussed the use of anti-virals and steroids in patients with COVID-19.Additionally, we have also highlighted the current guidelines for steroid use in COVID-19 patients.
Q2.In the conclusion, it would be advisable for the authors to concentrate more closely on the designated topic of the paper, which is complications.This focus would enhance the relevance and coherence of the findings in relation to the stated objectives of the research.A2.Thank you for the comment.The conclusion has been edited to better highlight the complications of COVID-19.

Competing Interests:
The authors declare that they have no competing interests.

Version 1
Reviewer Report 03 April 2024 https://doi.org/10.5256/f1000research.159695.r253907© 2024 Khuluq H.This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Husnul Khuluq Universitas Muhammadiyah Gombong, Kebumen, Indonesia
The literature is up-to-date, but it is insufficient with only 14 references.Bibliometric research is a review-based study, so it requires a more extensive collection of literature than experimental or observational research.The study design is sound, utilizing two databases: Scopus and Web of Science.However, a drawback of using these two databases is the difficulty in visualization with tools like VOSviewer or Biblioshiny.Bibliometric research should display network visualizations among institutions, countries, and author collaborations.Utilizing only Web of Science might actually be sufficient due to its more comprehensive visualization capabilities.The main weakness of this article is the absence of such visualizations, as explained above.Overall, bibliometric analysis should ideally utilize applications such as VOSviewer or Biblioshiny, wherein citation counts will automatically appear.The utilization of these applications is not explicitly stated within the research methodology.This article bears closer resemblance to a review article rather than a bibliometric analysis.
The literature is relevant, but the discussion lacks depth due to the scarcity of literature.The discussion on complications, which is the main topic, should be more detailed with literature from various countries, as complications may vary.
The conclusion remains too general and is not sufficiently relevant to its title, which is complications in COVID-19 cases.Please formulate a more specific conclusion and add recommendations.Reviewer Expertise: bibliometric , big data , machine learning, clinical pharmacy I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

Ans.
In response to your feedback, we have now revised the conclusion to be more specific and directly relevant to the content of the article.
Competing Interests: No competing interests were disclosed.
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©
2024 Gülhan P.This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Pinar Yildiz GülhanDuzce University, Konuralp, Duzce, TurkeyThe article provides a valuable overview of the 50 most cited articles on COVID-19 and its complications, highlighting key trends in publication, authorship, and research focus.The analysis of patient demographics, clinical features, and comorbidities offers insights into the factors influencing disease severity and outcomes.The discussion on complications and treatment options further enhances the clinical relevance of the study.However, the article could be strengthened by incorporating visual aids, expanding the discussion of certain findings, and providing more specific recommendations for future research.Overall, despite some limitations, the study serves as a useful resource for researchers and clinicians seeking a concise overview of the influential literature on COVID-19 complications.Tables can be visualised with VOSviewer and other bibliometric analysis programs.Is the work clearly and accurately presented and does it cite the current literature?YesIs the study design appropriate and is the work technically sound?YesAre sufficient details of methods and analysis provided to allow replication by others?YesIf applicable, is the statistical analysis and its interpretation appropriate?YesAre all the source data underlying the results available to ensure full reproducibility?YesAre the conclusions drawn adequately supported by the results?YesCompeting Interests: No competing interests were disclosed.Reviewer Expertise: ı m a pulmonogist and my research area is molecular biology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.Reviewer Report 10 May 2024 https://doi.org/10.5256/f1000research.165741.r273085© 2024 Khuluq H.This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

References 1 .
Khuluq H: The Impact of the COVID-19 Pandemic on Cardiovascular Disease Research: A Bibliometric Analysis.225: 745-757 Publisher Full Text 2. Husnul Khuluq, Prasandhya Astagiri Yusuf, Dyah Aryani Perwitasari: A bibliometric analysis of coronavirus disease (COVID-19) mortality rate.Bali Medical Journal.2022; 11 (2): 579-586 Publisher Full TextIs the work clearly and accurately presented and does it cite the current literature?PartlyIs the study design appropriate and is the work technically sound?PartlyAre sufficient details of methods and analysis provided to allow replication by others?YesIf applicable, is the statistical analysis and its interpretation appropriate?I cannot comment.A qualified statistician is required.Are all the source data underlying the results available to ensure full reproducibility?YesAre the conclusions drawn adequately supported by the results?PartlyCompeting Interests: No competing interests were disclosed.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, Chine: a description study.Lancet 2020; 395 (10223): 507-513 10 11163 5. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al.A pneumonia outbreak associated with a new coronavirus of probable bat origin.Nature 2020; 579: 270-273 11 10780 6. Wu F, Zhao S, Yu B, Chen MY, Wang W, Song GZ, et al.A new coronavirus associated with human respiratory disease in China.

Table 2 .
Year of publications of the top 50 most-cited COVID-19 articles.

Table 4 .
Authors contributing to the top 50 most-cited COVID-19 articles.

Table 5 .
Departmental affiliations of the authors contributing to the top 50 most-cited COVID-19 articles.

Table 3 .
Peer-reviewed journals that published the top 50 most cited articles of COVID-19.

Table 6 .
Countries involved in the top 50 most-cited COVID-19 articles.

Table 7 .
Study topic distribution among the top 50 most-cited articles.

Table 11 .
Clinical features among the patients with COVID-19 from the top 50 most-cited articles.

Table 9 .
Gender distribution among the patients with COVID-19 from the top 50 most-cited COVID-19 articles.

Table 10 .
Age distribution among the patients with COVID-19.

Table 13 .
List of comorbidities among the patients analyzed from the top 50 most-cited articles.

Table 14 .
Complications among the patients analyzed from the top 50 most-cited articles.OutcomeOf the total 22477 patients who tested positive with COVID-19, 12981 (57.8%) recovered without any complications, while 6998 (31.1%) patients were hospitalised, and 2498 (11.1%) patients deceased due to the illness (Table15).DiscussionIn the bibliometric analysis of the top 50 most-cited COVID-19 articles, the most cited article was "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China" by Huang C et al., in The Lancet published in 2020.This article has the highest total number of citations (24775) as well as the highest average number of citations per year (8258) among the top 50 most-cited articles.

Table 15 .
Outcomes of the patients with COVID-19.
This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.