key: cord-0988066-z3siwl56
authors: Yu, Caizheng; Lei, Qing; Li, Wenkai; Wang, Xiong; Li, Wengang; Liu, Wei
title: Epidemiological and clinical characteristics of 1663 hospitalized patients infected with COVID-19 in Wuhan, China: a single-center experience
date: 2020-07-17
journal: J Infect Public Health
DOI: 10.1016/j.jiph.2020.07.002
sha: 27aa830a786157f00a1f495cee7b01aa5f7dc00a
doc_id: 988066
cord_uid: z3siwl56

BACKGROUND: The COVID-19 outbreak in late December 2019 has quickly emerged into pandemic in 2020. We aimed to describe the epidemiology and clinical characteristics of hospitalized COVID-19 patients, and to investigate the potential risk factors for COVID-19 severity. METHOD: 1,663 hospitalized patients with laboratory-confirmed diagnosed COVID-19 from Tongji Hospital between January 14, 2020, and February 28, 2020 were included in the present study. Demographic information, exposure history, medical history, comorbidities, signs and symptoms, chest computed tomography (CT) scanning, severity of COVID-19 and laboratory findings on admission were collected from electronic medical records. Multivariable logistic regression was used to explore the association between potential risk factors with COVID-19 severity. RESULTS: In the present study, the majority (79%) of 1,663 COVID-19 patients were aged over 50 years old. A total of 2.8% were medical staff, and an exposure history of Huanan seafood market was document in 0.7%, and 7.4% were family infection. Fever (85.8%), cough (36.0%), fatigue (23.6%) and chest tightness (11.9%) were the most common symptoms in COVID-19 patients. As of February 28, 2020, of the 1,663 patients included in this study, 26.0% were discharged, 10.2% were died, and 63.8% remained hospitalized. More than 1/3 of the patients had at least one comorbidity. Most (99.8%) patients had abnormal results Chest CT, and the most common manifestations of chest CT were local patchy shadowing (70.7%) and ground-glass opacity (44.8%). On admission, lymphocytopenia was present in 51.1% of the patients, mononucleosis in 26.6%, and erythrocytopenia in 61.3%. Most of the patients had increased levels of C-reactive protein (80.4%) and D-dimer (64.4%). Compared with non-severe patients, severe patients had more obvious abnormal laboratory results related to inflammation, coagulation disorders, liver and kidney damage (all P <0.05). Older age (OR = 2.37, 95% CI: 1.47-3.83), leukocytosis (OR = 2.37, 95% CI: 1.47-3.83), and increased creatine kinase (OR = 2.37, 95% CI: 1.47-3.83) on admission were significantly associated with COVID-19 severity. CONCLUSION: Timely medical treatment and clear diagnosis after the onset might be beneficial to control the condition of COVID-19. Severe patients were more likely to be to be elder, and tended to have higher proportion of comorbidities and more prominent laboratory abnormalities. Older age, leukocytosis, and increased creatine kinase might help clinicians to identify severe patients with COVID-19.

Since early December 2019, several pneumonia cases of unknown origin were identified in Wuhan, Hubei province, China [1, 2] . The pathogen has been identified as a novel coronavirus and belongs to β-coronavirus genus that has been named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by International Committee on Taxonomy of Viruses [3] . Additionally, the pneumonia caused by SARS-CoV-2 has been named as coronavirus disease 2019 (COVID-19) by World J o u r n a l P r e -p r o o f Health Organization (WHO) [4] . COVID-19 has soon become a serious worldwide health problem and was declared as pandemic in March 2020 [5] [6] [7] [8] . By June 16, 2020, 7 .94 million cases were confirmed globally, including 84.82 thousand cases in China and 434.80 thousand patients have died from this viral infection worldwide, 4.65 thousand in China [7] . This novel virus shared 79.5% sequence identify to severe acute respiratory syndrome coronavirus (SARS-CoV), and spread from person to person [9] [10] [11] .

Many studies have reported the clinical characteristics of COVID-19 patients [1, 5, [12] [13] [14] , but the outbreak is still progressing, an updated analysis of cases in a relative large sample might help identify the defining the epidemiology and clinical features of COVID-19.

In the present study, we aimed to describe the epidemiology and clinical characteristics of 1,663 hospitalized COVID-19 patients at single-center hospital, and to explore the associations between potential risk factors with COVID-19 severity.

We obtained the medical records for 1,663 hospitalized patients with laboratory-confirmed diagnosed COVID-19 from Tongji Hospital between January 14, 2020, and February 28, 2020. Admission criteria: the patient has clinical symptoms, a positive nucleic acid test, or CT suggests viral pneumonia. Demographic information, exposure history (Huanan seafood market exposure and family infection), medical history, comorbidities, signs and symptoms, chest computed tomography (CT) J o u r n a l P r e -p r o o f scanning, severity of COVID-19 and laboratory findings on admission were collected from electronic medical records. More detailed information on fundamentals and method has been previously reported elsewhere [15] . The study was approved by Tongji Hospital Ethics Committee.

Severity of COVID-19 was defined according to the diagnostic and treatment guideline (Version 5-6) published by the government [16, 17] . Severe COVID-19 was defined if they meet one of following criteria: (1) Respiratory distress with respiratory frequency ≥ 30 breaths per min with shortness of breath or difficulty breathing; (2) Oxygen saturation ≤ 93% at rest; (3) Artery partial pressure of oxygen (PaO2)/inspired oxygen fraction (FiO2) ≤ 300 mmHg (1mmHg = 0.133kPa).

Throat swab specimens were collected for the SARS-CoV-2 viral nucleic acid detection and stored in 5 mL virus preservation solution. Virus RNA was extracted with 24 h on Tianlong PANA9600 automatic nucleic acid extraction system (Tianlong, China 

On January 20, COVID-19 was included in the legal category B infectious diseases in 

Of 1,663 patients, the main clinical symptoms were fever (85.8%), cough (36.0%), fatigue (23.6%) and chest tightness (11.9%), followed by diarrhea (4.6%), dyspnea Figure 3C ) and atelectasis (0.4%, Figure 3D ).

Compared with non-severe patients, the severe patients had a higher proportion of symptoms such as pleural effusion and bronchiectasis (all P<0.01).

As Table 3 shown, most of patients had normal white blood cell count (81.2%), with 9.2% increased and 9.6% decreased cases on admission. Compared to non-severe patients, severe individuals tended to have higher levels of white blood cell count, neutrophil count/ percentage, platelet count, aspartate aminotransferase, urea, lactate dehydrogenase, and procalcitonin (all P<0.05, Table 3 ).

In addition, severe patients had lower levels of lymphocyte count/percentage, monocyte percentage, hemoglobin, and albulmin (all P<0.05, Table 3 ). Prothrombin time was longer in severe patients than in non-severe patients. In the present study, we observed that non-severe and severe patients had higher levels of D-dimer. Compared 

In the present study, the majority (79%) of 1,663 COVID-19 patients were aged over 50 years old. A total of 2.8% were medical staff, and an exposure history of Huanan seafood market was document in 0.7%, and 7.4% were family infection. Fever 

The median age (64.0 y, IQR, 52.0-71.0) of all patients in the present study were older than other studies, which might be associated with the fact that more serious patients were admitted to Tongji hospital. Moreover, severe patients tended to be elder, when compared to non-severe patients, which was consistent with the previous findings [12] .

In the present study, 2.8% of the patients were medical staff, and the percentage is lower than that reported by Wang et al., which might due to the size of the sample and policy of the hospital [14] . In the present study, we found that severe and non-severe patients had a significant difference regarding the median days from symptom onset to hospital admission and from onset of symptoms to COVID-19 confirmation, which might indicate that timely medical treatment after the onset might be beneficial to control the condition.

Hypertension, diabetes mellitus and cardiovascular diseases were the most common underlying diseases, consistent with other previous studies [12] [13] [14] . In addition, we found severe patients had higher proportion of comorbidity such as hypertension, diabetes and coronary heart disease, which was consistent with Guan's report based on 1099 patients from 552 hospitals. However, Zhang et al. did not observed the similar findings, which might be associated with study sample size, different age and gender of the study subjects.

In line with previous study [12] [13] [14] 18] , of 1,663 patients in the present study, the main clinical symptoms were fever, cough, fatigue and chest tightness. We found serious patients had a higher proportion of symptoms such as fever, cough, fatigue, chest tightness and loss of appetite, which was consistent with the study conducted by proportion of symptoms such as fever, cough, and chest tightness after further excluding the patients with underlying diseased. However, several previous researches [12] [13] [14] did not found the significant difference. The most common manifestations of chest CT were local patchy shadowing and ground-glass opacity, which were consistent with previous studies [12, 19] . Additionally, we observed that the severe patients had a higher proportion of symptoms such as pleural effusion and bronchiectasis, when compared with non-severe patients, which had not been reported yet.

Consistent with previous studies [12] [13] [14] 18] , most of patients had normal white blood cell count, decreased levels of lymphocyte count/percentage, hemoglobin, and albulmin, increased levels of lactate dehydrogenase, C-reactive protein, increased D-dimer, procalcitonin, alanine aminotransferase, and aspartate aminotransferase.

These abnormal laboratory findings showed sustained inflammatory response, disturbed coagulation mechanism, liver and kidney damage after patients infected [12] . Compared to non-severe patients, severe individuals tended to have higher levels of white blood cell count, neutrophil count/ percentage, platelet count, aspartate aminotransferase, urea, lactate dehydrogenase, D-dimer, and procalcitonin, which indicated severe patients might have more obvious inflammation, disturbed coagulation mechanism, liver and kidney damage. Previous study found that five COVID-19 patients younger than 50 years had a large-vessel stroke [20] , which indicated that COVID-19 might increase the risk of cardiovascular disease. In the J o u r n a l P r e -p r o o f present study, we also found that non-severe and severe patients had higher levels of D-dimer. Additionally, we observed that leukocytosis and increased creatine kinase were positively associated with COVID-19 severity.

The strengths of present study included the relatively large sample size, and the ability to provide more information of epidemiological and clinical characteristics of patients infected with COVID-19. It would enable us to investigate the associations between potential risk factors and COVID-19 severity with moderate statistical power.

Different from previous studies [15, 21, 22] , the present study was the first comprehensive analysis of 1,663 hospitalized patients with laboratory-confirmed diagnosis of COVID-19 from January 14, 2020 to February 28, 2020 in Tongji Hospital. Nonetheless, some limitations should be taken into consideration. Firstly, the present study was performed in single-center thus the findings may not be representative of general population. Secondly, we have not yet collected information on treatments in the present study.

In the present study, the majority of all COVID-19 patients were aged over 50 years old. Fever, cough, fatigue and chest tightness were the most common symptoms in 

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Data are medians (IQR) or No./total No. (%)

The authors would like to thank all study subjects for participating in the present study.J o u r n a l P r e -p r o o f