BACKGROUND AND PURPOSE:

• Wang et al. (JAMA, 2020) described clinical and epidemiological characteristics of patients with COVID-19 in Wuhan, China

METHODS:

• Retrospective, single-center case series
• Participants
  • All 138 consecutive hospitalized patients with confirmed COVID-19 at Zhongnan Hospital of Wuhan University in Wuhan, China from January 1 to January 28, 2020
• Exposures
  • Documented cases
• Study design
  • The following data were collected: epidemiological, demographic, clinical, laboratory, radiological, and treatment data
  • The authors compared outcomes of critically ill patients and noncritically ill patients

RESULTS:

• 138 patients | Median age was 56 (Range, 22-92 years) | 54.3% were men
• Hospital-associated transmission was suspected as the presumed mechanism of infection for
  • Affected health professionals: 29%
  • Hospitalized patients: 12.3%

Symptoms

• Common symptoms
  • Fever: 98.6%
  • Fatigue: 69.6%
  • Dry cough: 59.4%
• Lymphopenia: 70.3%
  • Lymphocyte count, 0.8 × 109/L (interquartile range [IQR], 0.6 to 1.1)
• Prolonged prothrombin time: 58%
  • 13.0 seconds (IQR, 12.3 to 13.7)
• Elevated lactate dehydrogenase: 39.9%
  • 261 U/L (IQR, 182 to 403)
• CT findings: Bilateral patchy shadows or ground glass opacity in the lungs of all patients

Therapies and Treatment

• Antiviral therapy
  • Oseltamivir: 89.9%
• Antibacterial therapy
  • Moxifloxacin: 64.4%
  • Ceftriaxone: 24.6%
  • Azithromycin: 18.1%
• Glucocorticoid therapy: 44.9%

ICU Admission

• ICU transfer rate: 26.1%
• Indications for transfer
  • ARDS: 61.1%
  • Arrhythmia: 44.4%
  • Shock: 30.6%
• Median time from first symptom to
  • Dyspnea: 5.0 days
  • Hospital admission: 7.0 days
  • ARDS: 8.0 days
• Compared to patients not treated in the ICU (n = 102), patients treated in the ICU (n = 36) were
  • Older: Median age: 66 years vs 51 years
  • More likely to have underlying comorbidities: 72.2% vs 37.3%
  • More likely to have dyspnea: 63.9% vs 19.6%
  • More likely to have anorexia: 66.7% vs 30.4%
• Of the 36 cases in the ICU
  • 11.1% received high-flow oxygen therapy
  • 41.7% received noninvasive ventilation
  • 47.2% received invasive ventilation (4 were switched to ECMO)

Outlook

• Discharged: 34.1%
• Mortality: 4.3%
• Among those discharged alive Median hospital stay was 10 days (IQR, 7.0 to 14.0)
• Many of the patients were still hospitalized at the time of publication

CONCLUSION:

• The authors did not find use of antibacterial agents, oseltamivir or methylprednisolone to be effective
• The authors further state that

…abnormalities suggest that 2019-nCoV infection may be associated with cellular immune deficiency, coagulation activation, myocardia injury, hepatic injury, and kidney injury

These laboratory abnormalities are similar to those previously observed in patients with MERS-CoV and SARS-CoV infection

Learn More – Primary Sources:

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

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