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Clinical Characteristics of COVID-19 in Fujian Province: a Multicenter Retrospective Study

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Clinical Characteristics of COVID-19 in Fujian Province: a Multicenter Retrospective Study Clinical characteristics of COVID-19 in Fujian Province: a multicenter retrospective study Sijiao Wang Zhongshan Hospital Fudan University Zhisheng Chen Xiamen Branch Zhongshan Hospital Fudan University Yijian Lin Quanzhou First Hospital of Fujian Medical University Li Lin Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Aliated Hospital of Fujian Medical University Qunying Lin Putian University Sufang Fang Fuzhou Pulmonary Hospital of Fujian province Yonghong Shi Xiamen University Aliated First Hospital Xibin Zhuang Quanzhou First Hospital of Fujian Medical University Yuming Ye Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Aliated Hospital of Fujian Medical University Ting Wang Fuzhou Pulmonary Hospital of Fujian province Hongying Zhang Fuzhou Pulmonary Hospital of Fujian province Changzhou shao ( [email protected] ) Zhongshan Hospital Fudan University https://orcid.org/0000-0002-1174-2654 Research Keywords: COVID-19; SRAS-CoV-2; Clinical characteristics; Old age Posted Date: April 8th, 2020 Page 1/20 DOI: https://doi.org/10.21203/rs.3.rs-21268/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 2/20 Abstract Background The coronavirus disease 2019 (COVID-19) has spread worldwide, leading to thousands of deaths. We aim to describe the epidemiological and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) in Fujian province, China. Methods In this retrospective, multi-center study, we collected and analysed 165 patients of COVID-19 conrmed by real time PCR of nasopharyngeal swab specimens in ve tertiary hospitals of Fujian province, China from Jan 22 to Feb 16, 2020. The nal date of follow-up was February 21, 2020. Results Of the 165 hospitalized patients with COVID-19, 101 patients had relation with Wuhan within two weeks. Symptoms at illness onset mainly were fever (76.4%), cough (60%) and expectoration (38.2%). On admission, the severity of most patients were classied as mild or common and lymphopenia (33.9%), hypoxemia (15.2%), elevated and bilateral pneumonia (83.6%) was observed. Patients older than 65 years had signicantly high frequency of hypertension, diabetes, severe classication, lymphopenia and hypoxemia than those younger than 65 years. Age correlated negatively with lymphocyte count and oxygenation index on admission while positively with duration from exposure to the time of negative RT- PCR. At the end of follow-up, 80 patients were discharged and one died. The median hospital stay was 17 days. Conclusions Patients with COVID-19 were mostly non-severe cases in Fujian province and older patients (>65 years) were more likely to have lymphopenia and hypoxemia, and to progress as severe cases of COVID-19 than those younger than 65. Introduction The coronavirus disease 2019 (COVID-19) has spread throughout China and worldwide, since rstly began in Wuhan, China in December, 2019 [1–3]. The causative pathogen, severe acute respiratory coronavirus 2 (SARS-CoV-2), became the third coronavirus that cause deadly and disruptive epidemic of acute respiratory disease after SARS-CoV (severe acute respiratory syndrome coronavirus) and MERS- CoV (Middle East respiratory syndrome coronavirus) in 21st century [4, 5]. Next-generation sequencing and phylogenetic analysis suggested that SARS-CoV-2 is a novel beta coronavirus from subgenus Sarbecovirus and bats might be its original hosts [6]. The disease could transmit from person to person through respiratory droplets and close contacts [7–9] and the pathogen was also found in excrements of infected patients [10]. As of April 1, 2020, about 823,000 infected patients had been conrmed globally with 40,598 deaths and the global risk has been assessed very high since February 28, 2020 [11]. Page 3/20 Several early studies about Wuhan, the initial epicenter of COVID-19, had described that clinical features were mainly fever, cough, dyspnea, myalgia, fatigue, normal or decreased leukocyte counts, and case of fatal mortality rate was as high as 11% or even 15% [12, 13]. Moreover, patients in ICU were mostly older with underlying comorbidities [14], in consistent with two studies that demonstrated older patients (> 65 years) were more likely to develop acute respiratory distress syndrome (ARDS), which increased the risk of death [15, 16], indicating old age is an important factor of COVID-19 infection. In addition, a report showed that symptoms of patients with COVID-19 in Zhejiang province were milder compared with initially infected patients in Wuhan and the clinical features of COVID-19 in Jangsu province and Beijing were also both similar to that in Zhejiang [17–19]. However, no study have revealed the situation of COVID-19 in Fujian province. In this study, we aim to describe the epidemiological and clinical characteristics of COVID-19 during late-January to mid-February 2020 in Fujian Province, China. We also further investigate and provide more evidence to show the effects old age plays in this highly infectious disease. Methods Study Design and Participants We performed a retrospective, multi center study of165 patients who were enrolled from 22 January 2020 to 16 February 2020 in hospitals responsible for the treatments for CoVID-19 assigned by the government in Fuzhou, Zhangzhou, Xiamen, Putian, Quanzhou of Fujian province. This study was approved by ethical committee in Zhongshan Hospital, Xiamen Branch, Fudan University. In light of the urgent need to collect data, the requirement for informed consent was waived. The clinical outcomes were monitored up to February 21, 2020. Data Collection Nasopharyngeal swab specimens from the upper respiratory tract were obtained from all patients on admission and send to the local Centers for Disease Control to test RNA of SARS-CoV-2 by real time reverse transcription polymerase chain reaction (RT PCR). Demographics (age, sex, BMI), exposure history (Wuhan stay history and contact history with conrmed patients), clinical characteristics (ie, comorbidities, symptoms from onset to admission), laboratory ndings, radiological characteristics, treatment (ie, antiviral agents, antibiotics corticosteroids, Chinese medicine), and outcomes (hospitalization, discharge or death) from electronic medical records were collected. Clinical outcomes were followed up to February 21, 2020. If data were conicting or missing from records, we communicated directly with patients or their families to ascertain. Data were checked by a team of professional physician. Denitions Page 4/20 The date of illness onset was dened as the day when the symptom was noticed and the incubation period was dened as the time from exposure to the illness onset [20]. Familial clusters was identied as situation that two or more patients were infected in the same family within two weeks. We dened the degree of severity of COVID-19 at the time of admission using Curb-65 score.[21] In addition, according to the seventh edition of diagnosis and treatment program of 2019 novel coronavirus pneumonia in China, patients were classied as four forms including mild, common, severe and critically ill. Briey, the mild and common were non-severe patients who had mild symptoms with or without radiological pneumonia manifestations. Severe and critically ill patients were dened as those who had dyspnea, hypoxemia, worsening of radiological imaging, or severe complications such as ARDS, respiratory failures or shock. The oxygenation index that arterial oxygen pressure (PaO) over inspiratory oxygen fraction (FiO) less than 300 mm Hg was dened as hypoxemia. Once disease progressed into another more severe form, it was regarded as aggravation. Statistical Analysis Continuous variables were presented as median (IQR) and categorical variables as frequency rates and percentage. The differences between older patients (> 65 years) and the young (18–65 years) were also assessed using two-sample independent group t tests or Mann-Whitney U test for continuous variables, and χ² test or Fisher’s exact test for categorical variables. Spearman's correlation test was used for calculation of correlation between age and indicators like lymphocyte count. The SPSS (version 22.0) was applied for all analyses and graphs was generated using Graphpad Prism version 8.0 software. P value < 0.05 was considered statistically signicant. Results Epidemiological and clinical characteristics Of the 165 hospitalized patients with SARS-CoV-2 infection, the median age was 44 (IQR 33–59.5, range 19–93; Table 1) years and 81 were men. A total of 102 patients had residing or short traveling history in Wuhan of which one had direct exposure to Huanan seafood market. Eleven (6.6%) patients had close contact with people from Wuhan. Thirteen family clusters were identied and the biggest one involved six persons. Approximately one third patients had coexisting diseases including hypertension (14.5%) and diabetes (8.2%). Naturally, older patients also had signicantly higher percentage of comorbidities than the young below 65 years. The median incubation period was 7 (IQR 4–12) days among 84 patients provided the exact contact date. The most common symptoms at onset of illness were fever (76.4%), cough (60%), expectoration (38.2%), and myalgia/fatigue (29.7%). The gastrointestinal symptom diarrhea were occurred in 14 (8.5%) patients and the typical upper respiratory tract symptoms rhinorrhea and nasal congestion were presented in nine (5.5%) patients. Eight asymptomatic patients who had contact with conrmed cases
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