key: cord-1006053-a5x5ga60
authors: Zhao, Zonghao; Xie, Jiajia; Yin, Ming; Yang, Yun; He, Hongliang; Jin, Tengchuan; Li, Wenting; Zhu, Xiaowu; Xu, Jing; Zhao, Changcheng; Li, Lei; Li, Yi; Mengist, Hylemariam Mihiretie; Zahid, Ayesha; Yao, Ziqin; Ding, Chengchao; Qi, Yingjie; Gao, Yong; Ma, Xiaoling
title: Clinical and Laboratory Profiles of 75 Hospitalized Patients with Novel Coronavirus Disease 2019 in Hefei, China
date: 2020-03-06
journal: nan
DOI: 10.1101/2020.03.01.20029785
sha: c8437a45bfb84fb206fe03fd18d28858bae32651
doc_id: 1006053
cord_uid: a5x5ga60

The outbreak of the novel coronavirus disease 2019 (COVID-19) infection began in December 2019 in Wuhan, and rapidly spread to many provinces in China. The number of cases has increased markedly in Anhui, but information on the clinical characteristics of patients is limited. We reported 75 patients with COVID-19 in the First Affiliated Hospital of USTC from Jan 21 to Feb 16, 2020, Hefei, Anhui Province, China. COVID-19 infection was confirmed by real-time RT-PCR of respiratory nasopharyngeal swab samples. Epidemiological, clinical and laboratory data were collected and analyzed. Of the 75 patients with COVID-19, 61 (81.33%) had a direct or indirect exposure history to Wuhan. Common symptoms at onset included fever (66 [88.0%] of 75 patients) and dry cough (62 [82.67%]). Of the patients without fever, cough could be the only or primary symptom. The most prominent laboratory abnormalities were lymphopenia, decreased percentage of lymphocytes (LYM%), decreased CD4+ and CD8+ T cell counts, elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH). Patients with elevated interleukin 6 (IL-6) showed significant decreases in the LYM%, CD4+ and CD8+ T cell counts. Besides, the percentage of neutrophils, CRP, LDH and Procalcitonin levels increased significantly. We concluded that COVID-19 could cause different degrees of hematological abnormalities and damage of internal organs. Hematological profiles including LYM, LDH, CRP and IL-6 could be indicators of diseases severity and evaluation of treatment effectiveness. Antiviral treatment requires a comprehensive and supportive approach. Further targeted therapy should be determined based on individual clinical manifestations and laboratory indicators.

fever, cough could be the only or primary symptom. The most prominent laboratory 47 abnormalities were lymphopenia, decreased percentage of lymphocytes (LYM%), 48 decreased CD4 + and CD8 + T cell counts, elevated C-reactive protein (CRP) and 49 lactate dehydrogenase (LDH). Patients with elevated interleukin 6 (IL-6) showed 50 significant decreases in the LYM%, CD4 + and CD8 + T cell counts. Besides, the 51 percentage of neutrophils, CRP, LDH and Procalcitonin levels increased significantly. 52 We concluded that COVID-19 could cause different degrees of hematological 53 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . https: //doi.org/10.1101 //doi.org/10. /2020 CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 114 We also examined other respiratory viruses, including influenza, avian influenza, 115 respiratory syncytial virus, adenovirus, parainfluenza virus, SARS-CoV and 116 MERS-CoV, with realtime RT-PCR. Hematological parameters including blood 117 routine, blood biochemistry, coagulation profile, and infection-related biomarkers 118 were recorded. Plasma cytokine interleukin 6 (IL-6) levels were detected by ELISA. 119 And the CD4 + and CD8 + T cell subsets were counted using flow cytometry. 120 Statistical analysis 121 We presented continuous measurements as median (IQR) and categorical variables 122 as number (%). Continuous variables were analyzed using the Mann-Whitney test. 123 For laboratory results, we also assessed whether the measurements were outside the 124 normal range. Graphpad prism 8.3 was used for all analyses. A two-sided α of less 125 than 0.05 was considered statistically significant.

Totally, 75 patients diagnosed with COVID-19 were included in this study. Among 128 them, 61 (81.33%) patients had been to Wuhan or exposed to people who came from diabetes, chronic kidney disease, respiratory system disease, nervous system disease, 135 chronic liver diseases, and malignant tumor (Table 1) .

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint Only a small proportion had sputum, fatigue, poor appetite and chest tightness (Table   144 2). 145 The blood counts of patients on admission showed leucopenia (white blood cell (Table 3) . 157 Fifteen patients had differing degrees of liver function abnormality, with alanine 158 aminotransferase (ALT) or aspartate aminotransferase (AST) above the normal range. (Table 3 ). These findings suggested that 165 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . https://doi.org/10.1101/2020.03.01.20029785 doi: medRxiv preprint the internal organs could also be potential targets of Regarding the infection index, most patients showed elevated C-reactive protein 167 (CRP) and Erythrocyte sedimentation rate (ESR) levels. Procalcitonin (PCT) was 168 elevated in 2 out of 59 patients. Forty-nine patients were tested for IL-6, and 14 169 (28.57%) of them showed levels above the normal range (Table 3) CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . https://doi.org/10.1101/2020.03.01.20029785 doi: medRxiv preprint more than 50% patients. The most significant was the decreased CD4 + T cell counts. 194 Previous studies of patients in Wuhan suggested virus invasion could induce a 195 cytokine storm syndrome (CRS) [5, 8] . Of the 14 patients with elevated IL-6, LYM%, 196 CD4 + and CD8 + T cell counts were significantly decreased and NEU%, CRP and 197 LDH levels increased significantly. Elevated IL-6 may be an important factor leading 198 to T lymphocytes damage and cellular immune deficiency. IL-6 could also be used as 199 an indicator to evaluate infection severity. Therefore, we conclude that IL-6 may be an Currently, there is no specific therapy for patients with new coronavirus pneumonia. 220 The pathologic mechanisms of disease progression and exacerbation are also unclear. 221 How to relieve the clinical symptoms of critically ill patients, and reduce the severity 222 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 269 We declare no competing interests. 

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . https: //doi.org/10.1101 //doi.org/10. /2020 CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . https: //doi.org/10.1101 //doi.org/10. /2020 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . https: //doi.org/10.1101 //doi.org/10. /2020 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Table 4 . Laboratory findings of patients with elevated and normal IL-6 level 338

Elevated IL-6 (n=14) Normal IL-6 (n=35) P value

Leucocytes (×10 9 per L; normal range 3.5-9.5) 6.23 (4.13-6.86) 5.44 (3.9-6.63) 0.45 Neutrophils (×10 9 per L; normal range 1. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10. 1101 /2020 

Creatine kinase (IU/L; normal range 22

Lactate dehydrogenase (U/L

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.(which was not peer-reviewed) The copyright holder for this preprint . https: //doi.org/10.1101 //doi.org/10. /2020 Abbreviation: IL-6, Interleukin-6. 339 Data are presented as median (IQR) or n/N (%). Statistical analysis, Mann-Whitney test. P values 340 indicate differences between patients with elevated and normal IL-6 level. * P < .05 was 341 considered statistically significant. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . https://doi.org/10.1101/2020.03.01.20029785 doi: medRxiv preprint (interquartile range, IQR) and analyzed by Mann-Whitney test. All statistical analyses were 366 performed using GraphPad Prism 8.3. P values indicate differences between patients with elevated 367 and normal IL-6 level ( * p<.05, ** p<.005, *** p<.001). P <.05 was considered statistically 368 significant. 369Abbreviations: IL-6, Interleukin-6; lymphocytes percentage, LYM%; neutrophil percentage, 370 NEU%; lactate dehydrogenase, LDH; C-reactive protein, CRP. 371 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.(which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10. 1101 /2020