Aggarwal Amit, Shrivastava Abhinav, Kumar Abhinav, Ali Adila
Specialist (Medicine), ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi.
Senior Resident (Cardiology), ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi.
J Assoc Physicians India. 2020 Jul;68(7):19-26.
Rapid spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Wuhan, China, prompted heightened surveillance in India. Since the first laboratory confirmed case of SARS-CoV-2 was reported from Kerala on January 30, 2020 novel coronavirus infected pneumonia (NCIP) has been presenting to the hospital emergencies as severe acute respiratory illness (SARI). We aim to find out the rate of SARS-CoV-2 positivity in SARI cases and further clarify the epidemiological and clinical characteristics of NCIP in New Delhi, India.
To find out the rate of SARS-CoV-2 positivity in SARI cases presenting to the hospital emergency and describe the epidemiological and clinical characteristics of NCIP.
DESIGN, SETTING AND PARTICIPANTS: Retrospective, single-center case series of the 82 consecutive hospitalized patients with SARI and subsequent confirmed NCIP cases at Dr Ram Manohar Lohia Hospital, New Delhi between 10th April 2020 and 30th April 2020.
Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. The primary composite end-point was admission to an intensive care unit (ICU), the use of mechanical ventilation or death. Patients were categorized as severe pneumonia and non-severe pneumonia at time of admission and outcome data was compared.
Of the 82 SARI cases, 32(39%) patients were confirmed to be SARS-CoV-2 positive. The median age of NCIP cases was 54.5 years (IQR, 46.25 - 60) and 19(59.3%) of them were males. 24(75%) cases were categorized as severe pneumonia on admission. 22(68.8%) patients had 1 or more co-morbidities. Diabetes mellitus 16(50%), hypertension 11(34.4%) and chronic obstructive airway disease 5(15.6%) were the most common co-existing illnesses. Compared with the patients who did not meet the primary outcome, patients who met the primary outcome were more likely to be having at least 1 underlying comorbidity (p-0.03), diabetes (p-0.003) and hypertension (p-0.03). Common symptoms included dyspnea 29(90.6%) followed by cough 27(84.4%), fever 22(68%), bodyache and myalgias 14(43.75%). Median time from symptom onset to hospital admission was 3 days. The most common pattern on chest X-ray was bilateral patchy nodular or interstitial infiltration seen in 30(93.8%) patients. Leucopenia was present in 10(31.2%) of the patients, with majority of patients presenting with lymphocytopenia, 24(75%) [lymphocyte count (1106 cells/ dL), interquartile range {IQR}, (970-1487)]. Thrombocytopenia was seen in 14(43.8%) patients, pancytopenia in 10(31.2%) patients and anemia was seen in 14(43.8%) patients. Hypoalbuminemia was present in 22(68.8%) cases. Raised CK-MB was seen in 7(21.9%) patients. The primary composite end-point occurred in 12(37.5%) patients, including 9(28.13%) patients who required mechanical ventilation and subsequently expired. 3(9.3%) of these patients who recovered, were subsequently shifted to COVID-19 ward from the ICU. The patients who met the primary outcome were older in age (56.5 years vs 50 years), had significantly higher SOFA scores (6 vs 3.5), were in shock (41.7% vs 5%), in higher respiratory distress (66.7% vs 10%), had lower mean arterial oxygen saturation (85% vs 89.5%), had higher CK-MB values (66 vs 26)U/L [6(54.5%) vs 2(9.5%)], had hypoalbuminemia (100% vs 50%) and acute kidney injury 8(72.7%) vs 5(23.8%) on admission. Of the 50 non-COVID-19 SARI patients in our study cohort, 13 (26%) patients met the primary composite outcome. Of them 9 (18%) patients expired and remaining 4 patients have subsequently recovered. As on 17th May 2020, 23 patients were still hospitalized, recovering in COVID-19 ward.
In this single-center case series from New Delhi, out of 82 patients of SARI, 32 patients were confirmed NCIP, with a COVID-19 positivity of 39%. 75% of NCIP presented in severe pneumonia and 37.5% required ICU care. The case fatality rate was 28%.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）在中国武汉的迅速传播促使印度加强了监测。自2020年1月30日喀拉拉邦报告首例实验室确诊的SARS-CoV-2病例以来，新型冠状病毒感染肺炎（NCIP）一直以严重急性呼吸疾病（SARI）的形式出现在医院急诊中。我们旨在找出SARI病例中SARS-CoV-2阳性率，并进一步阐明印度新德里NCIP的流行病学和临床特征。
找出到医院急诊就诊的SARI病例中SARS-CoV-2阳性率，并描述NCIP的流行病学和临床特征。
设计、地点和参与者：这是一项回顾性、单中心病例系列研究，研究对象为2020年4月10日至4月30日期间在新德里拉姆·马诺哈尔·洛希亚医院连续住院的82例SARI患者及随后确诊的NCIP病例。
收集并分析流行病学、人口统计学、临床、实验室、放射学和治疗数据。主要复合终点为入住重症监护病房（ICU）、使用机械通气或死亡。患者在入院时被分为重症肺炎和非重症肺炎，并比较结局数据。
在82例SARI病例中，32例（39%）患者被确诊为SARS-CoV-2阳性。NCIP病例的中位年龄为54.5岁（四分位间距，46.25 - 60岁），其中19例（59.3%）为男性。24例（75%）病例入院时被分类为重症肺炎。22例（68.8%）患者有一种或多种合并症。糖尿病16例（50%）、高血压11例（34.4%）和慢性阻塞性气道疾病5例（15.6%）是最常见的并存疾病。与未达到主要结局的患者相比，达到主要结局的患者更有可能至少有一种基础合并症（p = 0.03）、糖尿病（p = 0.003）和高血压（p = 0.03）。常见症状包括呼吸困难29例（90.6%），其次是咳嗽27例（84.4%）、发热22例（68%）、身体疼痛和肌痛14例（43.75%）。从症状出现到入院的中位时间为3天。胸部X线最常见的表现是双侧斑片状结节或间质浸润，见于30例（93.8%）患者。10例（31.2%）患者出现白细胞减少，大多数患者表现为淋巴细胞减少，24例（75%）[淋巴细胞计数（1106个/ dL），四分位间距{IQR}，（970 - 1487）]。14例（43.8%）患者出现血小板减少，10例（31.2%）患者出现全血细胞减少，14例（43.8%）患者出现贫血。22例（68.8%）病例出现低白蛋白血症。7例（21.9%）患者肌酸激酶同工酶升高。12例（37.5%）患者出现主要复合终点，包括9例（28.13%）需要机械通气并随后死亡的患者。这些康复的患者中有3例（9.3%）随后从ICU转入COVID-19病房。达到主要结局的患者年龄较大（56.5岁对50岁），序贯器官衰竭评估（SOFA）评分显著更高（6对3.5），处于休克状态（41.7%对5%），呼吸窘迫程度更高（66.7%对10%）,平均动脉血氧饱和度更低（85%对89.5%），肌酸激酶同工酶值更高（66对26）U/L [6例（54.5%）对2例（9.5%）]，入院时出现低白蛋白血症（100%对50%）和急性肾损伤8例（72.7%）对5例（23.8%）。在我们研究队列的50例非COVID-19 SARI患者中，13例（26%）患者达到主要复合结局。其中9例（18%）患者死亡，其余4例患者随后康复。截至2020年5月17日，23例患者仍在住院，在COVID-19病房康复。
在新德里的这个单中心病例系列研究中，82例SARI患者中有32例确诊为NCIP，COVID-19阳性率为39%。75%的NCIP表现为重症肺炎，37.5%需要ICU护理。病死率为28%。
