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Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan

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Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China Downloaded from https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaa272/5807944 by University of California, San Francisco user on 24 March 2020 Zhongliang Wang1, MD; Bohan Yang2, MD; Qianwen Li1, MD; Lu Wen1, MD; Ruiguang Zhang1, MD. 1. Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; 2. Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Correspondence to: Ruiguang Zhang, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China. [email protected], +86 15071116896. Summary: In this retrospective case series that included 69 adults in Wuhan, 29% of patients showed dyspnea and 20% of cases showed SpO2<90%. Patients with SpO2<90% had a significantly higher risk of death. Abidol showed initial therapeutic effect. © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected]. ABSTRACT Background Downloaded from https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaa272/5807944 by University of California, San Francisco user on 24 March 2020 From December 2019 to February 2020, 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a serious outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China. Related clinical features are needed. Methods We reviewed 69 patients who were hospitalized in Union hospital in Wuhan between January 16 to January 29, 2020. All patients were confirmed to be infected with SARS-CoV-2 and the final date of follow-up was February 4, 2020. Results The median age of 69 enrolled patients was 42.0 years (IQR 35.0-62.0), and 32 patients (46%) were men. The most common symptoms were fever (60[87%]), cough (38[55%]), and fatigue (29[42%]). Most patients received antiviral therapy (66 [98.5%] of 67 patients) and antibiotic therapy (66 [98.5%] of 67 patients). As of February 4, 2020, 18 (26.9%) of 67 patients had been discharged, and five patients had died, with a mortality rate of 7.5%. According to the lowest SpO2 during admission, cases were divided into the SpO2≥90% group (n=55) and the SpO2<90% group (n=14). All 5 deaths occurred in the SpO2<90% group. Compared with SpO2≥90% group, patients of the SpO2<90% group were older, and showed more comorbidities and higher plasma levels of IL6, IL10, lactate dehydrogenase, and c reactive protein. Arbidol treatment showed tendency to improve the discharging rate and decrease the mortality rate. 2 Conclusions COVID-19 appears to show frequent fever, dry cough, and increase of inflammatory cytokines, Downloaded from https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaa272/5807944 by University of California, San Francisco user on 24 March 2020 and induced a mortality rate of 7.5%. Older patients or those with underlying comorbidities are at higher risk of death. Key words: coronavirus, pneumonia, Wuhan. 3 Introduction Coronaviruses are enveloped, single-stranded, positive-sense RNA viruses that are Downloaded from https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaa272/5807944 by University of California, San Francisco user on 24 March 2020 phenotypically and genotypically diverse, and widespread in bats around the world. Meanwhile, coronaviruses can also be found in many other species as well, including humans, other mammals, and birds. They may cause respiratory, enteric, hepatic, or neurologic diseases [1, 2]. In humans, there are four prevalent coronaviruses (229E, OC43, NL63, and HKU1), which typically cause common respiratory symptoms. Usually, the symptoms caused by coronaviruses are mild. But, in the past two decades, two other strains — severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) had caused two large-scale epidemics, with mortality rates of 10% for SARS-CoV and 37% for MERS-CoV [3]. In late December 2019, a series of cases with respiratory symptoms and typical chest computed X-ray tomography (CT) features were reported in Wuhan, Hubei, China. A previously unknown betacoronavirus was then discovered through the use of full-genome sequencing in samples from these patients, and was believed to be the pathogen of coronavirus disease 2019 (COVID-19) [4, 5]. The new betacoronavirus was named 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and formed another clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. COVID-19 has caused an outbreak in China since late December 2019 and continues to evolve with the number of suspected cases and deaths increasing daily in and outside of China. We describe the epidemiological, clinical, laboratory, and radiologic features, treatment, and 4 prognosis of patients with confirmed infection of SARS-CoV-2 who were hospitalized in Downloaded from https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaa272/5807944 by University of California, San Francisco user on 24 March 2020 Union Hospital, Wuhan. The difference of clinical features between the SpO2≥90% group and the SpO2<90% group would also been compared. Methods Patients In late December 2019, several hospitals of Wuhan reported clusters of patients with pneumonia of unknown cause, which was identified as SARS-CoV-2 soon after. The local government proclaimed a list of designated hospitals to treat patients infected with SARS-CoV- 2, including the Union hospital. Generally, the patients of Union hospital come from all regions of Wuhan, especially the Hankou district. In this program, all consecutive patients with confirmed COVID-19 admitted to the main campus of Union hospital from January 16 to January 29, 2020 were enrolled. All patients with COVID-19 enrolled in this study were diagnosed and admitted in accordance with the guideline of the national health commission of China [6]. The final date of follow-up was February 4, 2020. Data collection We reviewed clinical charts, nursing records, laboratory results, and chest CT characteristics for all patients. Epidemiological, clinical, imaging, and serological records and treatment and outcomes data were collected from the electronic medical network of Union hospital. To ensure the accuracy of data, two independent researchers were arranged to review and check the data form. 5 Real-time reverse transcription polymerase chain reaction tests (RT-PCR) The confirmation of COVID-19 is achieved by RT-PCR detection of throat swab samples of Downloaded from https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaa272/5807944 by University of California, San Francisco user on 24 March 2020 suspected patients. Following the recommendation of China National Center for Disease Control, two target genes were set as described previously [5], including open reading frame1ab (ORF1ab) and nucleocapsid protein (N), and simultaneously amplified and tested during the real-time RT-PCR assay. Target 1 (ORF1ab): forward primer CCCTGTGGGTTTTACACTTAA; reverse primer ACGATTGTGCATCAGCTGA; and the probe 5'-FAM-CCGTCTGCGGTATGTGGAAAGGTTATGG-BHQ1-3'. Target 2 (N): forward primer GGGGAACTTCTCCTGCTAGAAT; reverse primer CAGACATTTTGCTCTCAAGCTG; and the probe 5'-FAM- TTGCTGCTGCTTGACAGATT-TAMRA-3'. A cycle threshold value (Ct value) less than 37 was defined as a positive record, and a Ct-value exceeds 40 was defined as a negative test. Statistical analysis Continuous variables were reported as median (IQR), and compared with the Mann-Whitney U test. Categorical variables were reported as number and percentages, and compared by χ² test or Fisher’s exact test between the SpO2≥90% group and the SpO2<90% group, or the groups treated specific agent or not. Statistical analysis was performed with SPSS software (version 26.0). A P value of less than 0.05 was considered to indicate statistical significance. All probabilities are two-tailed. Results 6 The enrolled 69 patients were all confirmed infected with SARS-CoV-2 with PCR tests of throat swabs. The median age of the patients was 42.0 years (IQR 35.0-62.0, Table 1). Among Downloaded from https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaa272/5807944 by University of California, San Francisco user on 24 March 2020 them, 35 (51%) were aged 30-49 years, and 19 (28%) were aged 50-69 years (Figure 1). 32 patients (46%) were men, and 37 patients (54%) were women. According to the lowest SpO2 records during admission, we divided these patients into two groups: the SpO2≥90% group (n=55) and the SpO2<90% group (n=14). The median age of the SpO2≥90% group was 37.0 years (IQR 32.0-51.0), whereas the median age of the SpO2<90% group was 70.5 years (IQR 62.0-77.0). In the SpO2<90% group, the median occurrence time of lowest SpO2 was 1 day (IQR 0-2.0) after admission, and the median interval from onset of illness to time of lowest SpO2 during admission was 8.5 days (IQR 7.0-11.0). Of the 69 patients, less than half had underlying comorbidities (25[36%]), including hypertension (9[13%]), cardiovascular disease (8[12%]), and diabetes (7[10%]), et al. Patients of the SpO2<90% group showed more underlying comorbidities when compared with the SpO2≥90% group, such as hypertension (5[36%] vs 4[7%], p=0.014), cardiovascular disease (5[36%] vs 3[5%], p=0.07), and diabetes (6[43%] vs 1[2%], p<0.001). The most common clinical feature at the onset of illness was fever (60[87%]), 40 (58%) of them had a temperature reached 38.1-39.0°C and 13 (19%) of them had a temperature exceeded 39.0°C.
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