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Clinical Characteristics of Hospitalized Patients With 2019-nCoV–Infected Pneumonia in Wuhan
TAKE-HOME MESSAGE
- Among 138 patients hospitalized with novel coronavirus (2019-nCoV)–infected pneumonia, 54.3% were men. Infection among health professionals and hospitalized patients was assumed to be because of hospital-associated transmission. Common symptoms of the disease included fever, fatigue, and a dry cough. Other symptoms included lymphopenia, prolonged PTT, and increased LDH. All patients had patchy bilateral shadows and ground-glass opacity in the lungs on chest CT. Among those patients transferred to the ICU, 61.1% developed ARDS. Moreover, ICU patients were generally older, had underlying comorbidities, dyspnea, and anorexia.
- As of February 3, 2020, 47 patients were discharged and 6 patients had died. The rate of ICU-treated patients was 26%, and the mortality rate was 4.3%.
abstract
This abstract is available on the publisher's site.
Access this abstract nowImportance
In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
Objective
To describe the epidemiological and clinical characteristics of NCIP.
Design, Setting, and Participants
Retrospective, single-center case series of the 138 consecutive hospitalized patients with confirmed NCIP at Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 28, 2020; final date of follow-up was February 3, 2020.
Exposures
Documented NCIP.
Main Outcomes and Measures
Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. Presumed hospital-related transmission was suspected if a cluster of health professionals or hospitalized patients in the same wards became infected and a possible source of infection could be tracked.
Results
Of 138 hospitalized patients with NCIP, the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men. Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]). Common symptoms included fever (136 [98.6%]), fatigue (96 [69.6%]), and dry cough (82 [59.4%]). Lymphopenia (lymphocyte count, 0.8 × 109/L [interquartile range {IQR}, 0.6-1.1]) occurred in 97 patients (70.3%), prolonged prothrombin time (13.0 seconds [IQR, 12.3-13.7]) in 80 patients (58%), and elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55 patients (39.9%). Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]). The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days. Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102), were older (median age, 66 years vs 51 years), were more likely to have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%) received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17 (47.2%) received invasive ventilation (4 were switched to extracorporeal membrane oxygenation). As of February 3, 47 patients (34.1%) were discharged and 6 died (overall mortality, 4.3%), but the remaining patients are still hospitalized. Among those discharged alive (n = 47), the median hospital stay was 10 days (IQR, 7.0-14.0).
Conclusions and Relevance
In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.
Additional Info
Disclosure statements are available on the authors' profiles:
Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China
JAMA 2020 Feb 07;[EPub Ahead of Print], D Wang, B Hu, C Hu, F Zhu, X Liu, J Zhang, B Wang, H Xiang, Z Cheng, Y Xiong, Y Zhao, Y Li, X Wang, Z PengFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The outbreak of coronavirus disease 2019 (COVID-19) is a rapidly evolving situation, making it hard to keep abreast of ever-changing information. As of my last check, there were 76,214 reported cases and 2247 deaths.1 Two recent reports take us inside Chinese hospitals; one within the hot zone of Wuhan and the other in Beijing. Information from these locations can provide some guidance in regard to presentation and complications experienced by more severe cases.
The epicenter of COVID-19 is Wuhan (Hubei Provence, People’s Republic of China). A cases series of 138 consecutive novel coronavirus-infected pneumonia (NCIP) patients details the presentations and outcomes. The mean age was 56 years, with slightly more males (54%) than females (46%). Symptoms at onset included fever (99%), fatigue (70%), dry cough (59%), myalgia (35%), and dyspnea (31%). These individuals had depressed total lymphocyte counts, prolonged prothrombin times, and elevated LDH. About 1 of 4 patients required ICU care; they tended to be older and with more comorbid conditions. Typical progression from onset included the development of dyspnea at 5 days, hospitalization at 7 days, and ICU admission at 10 days. Patients requiring intensive care had higher WBC and neutrophil counts, and higher levels of D-dimer, creatine kinase, and creatinine. Common complications included shock (9%), ARDS (20%), arrhythmia (17%), and acute myocardial injury (7%). All patients, regardless of ICU admission, demonstrated bilateral lung involvement on chest CT. Of note, over 40% of the cases were likely hospital-acquired (12% patients and 29% healthcare workers).
The 13 patients from Beijing were younger, including 2 children, and demonstrated fever (92%), nasal congestion (62%), myalgia (23%), and headache (23%).2 C-reactive protein and lymphocyte counts were elevated. Only half of these patients had abnormalities on chest CT or chest radiographs. All of these patients recovered.
There are a couple of messages that I take away from these two studies. First, COVID-19 has myriad presentations, but fever is common in patients requiring hospitalization. This contrasts with our surveillance series of 344 ambulatory primary care patients with seasonal coronaviruses in which 49% report fever. Second, this is a highly contagious virus, which spreads easily within healthcare settings to other patients and to healthcare workers. As COVID-19 appears outside of China, principles of source control, use of personal protective equipment, and early detection become our most potent elements of prevention and control.
References