Author Topic: Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia  (Read 25 times)

mixin

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February 7, 2020

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%.

(2019 novel coronavirus (2019-nCoV)–infected pneumonia = (NCIP)

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).

https://jamanetwork.com/journals/jama/fullarticle/2761044

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epsilon

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First large scale clinical study (n>1000 patients from all over China)

https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1

Key points:

Fatality rate "only" 1.5%, definitely below SARS / MERS

BUT:
"Of 840 patients who underwent chest computed tomography on admission, 76.4% manifested as
pneumonia" -> not good


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Oxygen therapy, mechanical ventilation were initiated in 38.0%, 6.1% of patients, respectively

Definitely not good. Means gigantic hospital/ICU capacity necessary to deal with community outbreak.

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Notably, fever occurred in only 43.8% of patients ... such patients may be missed if the surveillance case definition focused heavily on fever detection

Not good.

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The median incubation period was 3.0 days (range, 0 to 24.0) i.e. shorter than a recent report (3.0 days vs. 5.2 days) [8]

Most worrying finding because it means the virus spreads exponentially twice as fast as presumed.
-> Case doubling period may be even LESS THAN 3 DAYS (depending on R0>3)

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we might have missed asymptomatic or mild
cases managed at home, and hence our cohort might represent the more severe end of 2019-nCoV

This is reassuring. Hopefully mild clinical spectrum will turn out to be large majority rather than the pneumonia cases.