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Patient Predisposition at Hospital Admission Indirectly Dictates Disease Severity, Clinical Course and Outcomes of COVID-19 Pneumonia Patients in Wuhan, China

40 Pages Posted: 2 Mar 2020

See all articles by Ronghui Du

Ronghui Du

Wuhan Respiratory Hospital - Department of Respiratory Medicine

Lirong Liang

Capital Medical University - Department of Clinical Epidemiology & Tobacco Dependence Treatment Research

Chengqing Yang

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1

Ming Li

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1

Guangyun Guo

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1

Nicholas van Halm-Lutterodt

Capital Medical University - Beijing Institute of Respiratory Medicine

Tanze Cao

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1

Chunlin Mei

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1

Juan Du

Wuhan Institute for Tuberculosis Control - Department of Tuberculosis Ward 4

Chunlan Zheng

Wuhan Institute for Tuberculosis Control - Department of Tuberculosis Ward 4

Tingping Wang

Wuhan Institute for Tuberculosis Control - Outpatient Office

Ming Hu

Wuhan Institute for Tuberculosis Control - Department of Critical Medicine

Zhaohui Tong

Capital Medical University - Department of Respiratory and Critical Care Medicine

Wen Wang

Capital Medical University - Department of Respiratory and Critical Care Medicine

Shuilian Chu

Capital Medical University - Department of Clinical Epidemiology & Tobacco Dependence Treatment Research

Xuyan Li

Capital Medical University - Department of Respiratory and Critical Care Medicine

Xianxiang Chen

Wuhan Institute for Tuberculosis Control - Department of Thoracic Surgery

Huanzhong Shi

Capital Medical University - Department of Respiratory and Critical Care Medicine

Weihua Wang

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1

More...

Abstract

Background: The epidemic outbreak of SARS-CoV-2 infective pneumonia still remains a clinical challenge in China. A full understanding of the clinical characteristics of hospital admitted SARS-CoV-2 infected patients as well as adequate clinical approach to treatment outcomes of these patients are still lacking.

Methods: A prospective analysis of 179 patients with COVID-19 pneumonia admitted to Wuhan Pulmonary Hospital from December 25th, 2019 to February 7th, 2020 were included in this study. At admission, all patients were trichotomized based on defined disease severity criteria: mild-to-moderate, severe, and critically-ill. The primary outcome measure was mortality incidence. Secondary outcomes included: rates of mechanical ventilation and intensive care unit (ICU) admission and major medical complications.

Findings: Of the 179 patients, (79/179) were mild-to-moderate, (57/179) were severe and (43/179) were critically-ill patients, respectively. The median age of the entire patient cohort was 57·6 years [interquartile range (IQR: 49·0–68·0) years]. The median age was [53·0 (IQR 44·0–61·0) years] for mild-to-moderate, [57·0 (IQR 49·0–70·0) years] for severe and [68·0 (IQR 62·0–72·0) years] for critically-ill patients, respectively, (P<0·001). A positive association of disease severity was observed with the incidence of common symptoms and co-morbidities (P<0·05). Overall mortality incidence was 11·7% (95% confidence interval, 7·0%–16·5%). Of the critically-ill patients, 12/43 (27·9%), 19/43 (44·2%) and 4/43 (9·3%) received non-invasive MV, invasive MV, and ECMO, respectively. Of all patients admitted to ICU, [22/179 (10·4%)], approximately 51·0% (22/43) accounted for patients in the critically-ill subgroup. Major complications included ARDS in 74/179 (41·3%), followed by septic shock in 23/179 (12·8%) and AKI in 14/179 (7·8%).

Interpretation: Our findings indicate that patient predisposing factors such as advanced age, underlying medical conditions and patients’ susceptibility to rapidly progress to ARDS status terminally determine clinical course, morbidity and mortality outcomes in SARS-CoV-2 infective pneumonia patients.

Funding Statement: This work was supported by Beijing Municipal Administration of Hospitals’ Mission Plan (SML20150301), and 1351 Talents Program of Beijing Chao-Yang Hospital (WXZXZ-2017-01).

Declaration of Interests: All authors declare no competing interests.

Ethics Approval Statement: Local research ethics boards (the Ethics Commission of Wuhan Pulmonary Hospital) approved the study (wufeilunli-2020-02) and waived the need for patients' written informed consent.

Keywords: SARS-CoV-2, influenza, pneumonia, advanced age, severity, ARDS, mortality, Wuhan, China

Suggested Citation

Du, Ronghui and Liang, Lirong and Yang, Chengqing and Li, Ming and Guo, Guangyun and van Halm-Lutterodt, Nicholas and Cao, Tanze and Mei, Chunlin and Du, Juan and Zheng, Chunlan and Wang, Tingping and Hu, Ming and Tong, Zhaohui and Wang, Wen and Chu, Shuilian and Li, Xuyan and Chen, Xianxiang and Shi, Huanzhong and Wang, Weihua, Patient Predisposition at Hospital Admission Indirectly Dictates Disease Severity, Clinical Course and Outcomes of COVID-19 Pneumonia Patients in Wuhan, China (February 19, 2020). Available at SSRN: https://ssrn.com/abstract=3543584 or http://dx.doi.org/10.2139/ssrn.3543584

Ronghui Du

Wuhan Respiratory Hospital - Department of Respiratory Medicine

China

Lirong Liang

Capital Medical University - Department of Clinical Epidemiology & Tobacco Dependence Treatment Research

Beijing
China

Chengqing Yang

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1

China

Ming Li

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1

China

Guangyun Guo

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1

China

Nicholas Van Halm-Lutterodt

Capital Medical University - Beijing Institute of Respiratory Medicine

China

Tanze Cao

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1

China

Chunlin Mei

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1

China

Juan Du

Wuhan Institute for Tuberculosis Control - Department of Tuberculosis Ward 4

China

Chunlan Zheng

Wuhan Institute for Tuberculosis Control - Department of Tuberculosis Ward 4

China

Tingping Wang

Wuhan Institute for Tuberculosis Control - Outpatient Office

China

Ming Hu

Wuhan Institute for Tuberculosis Control - Department of Critical Medicine

China

Zhaohui Tong

Capital Medical University - Department of Respiratory and Critical Care Medicine ( email )

China

Wen Wang

Capital Medical University - Department of Respiratory and Critical Care Medicine

China

Shuilian Chu

Capital Medical University - Department of Clinical Epidemiology & Tobacco Dependence Treatment Research

Beijing
China

Xuyan Li

Capital Medical University - Department of Respiratory and Critical Care Medicine

China

Xianxiang Chen

Wuhan Institute for Tuberculosis Control - Department of Thoracic Surgery

China

Huanzhong Shi (Contact Author)

Capital Medical University - Department of Respiratory and Critical Care Medicine ( email )

China

Weihua Wang

Wuhan Institute for Tuberculosis Control - Department of Respiratory and Critical Care Medicine Ward 1 ( email )

China

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