Department of Cardiology, Renmin Hospital of Wuhan University, China; Cardiovascular Research Institute, Wuhan University, China; Hubei Key Laboratory of Cardiology, China.
Department of Medical Affaires, Renmin Hospital of Wuhan University, China.
Clin Chim Acta. 2020 Nov;510:220-227. doi: 10.1016/j.cca.2020.06.051. Epub 2020 Jul 6.
Cases of coronavirus disease 2019 (COVID-19) have been breaking out around the world recently. However, the dynamic changes in the clinical symptoms and prognosis of COVID-19 patients remain unknown. According to the onset time of initial clinical symptoms, 843 COVID-19 patients admitted between Jan 22 and Feb 14, 2020 were divided into three groups: group A (Jan 21 to Jan 25, n = 324), group B (Jan 26 to Jan 31, n = 358) and group C (Feb 1 to Feb 10, n = 161). Data on the demographics, symptoms, first laboratory results, treatments and outcomes (within 12 days of hospitalization) were collected. The results showed that the median duration from symptom onset to admission shortened over time (13, 10 and 5 days, respectively, p < 0.05). Fewer patients had fever symptoms and bilateral pneumonia in group C than in the group A and B. Laboratory results showed that white blood cell, neutrophil, and platelet counts, lactic acid and D-dimer levels were lower, while lymphocyte, CD3, and CD8 counts were higher in group C. In addition, group C had more mild-moderate cases and fewer severe cases than the other two groups. More importantly, the incidence of complications (18.5%, 14.2% and 11.2%, respectively, p < 0.05) and all-cause mortality (11.7%, 8.4%, and 5.6%, respectively, p < 0.05) decreased over time. The clinical characteristics and prognosis of COVID-19 patients changed over time. Improved prognosis was found at a later stage.
近期，全球各地不断出现 2019 年冠状病毒病（COVID-19）病例。然而，COVID-19 患者的临床症状和预后的动态变化尚不清楚。根据初始临床症状的发病时间，将 2020 年 1 月 22 日至 2 月 14 日期间收治的 843 例 COVID-19 患者分为三组：A 组（1 月 21 日至 1 月 25 日，n=324）、B 组（1 月 26 日至 1 月 31 日，n=358）和 C 组（2 月 1 日至 2 月 10 日，n=161）。收集了患者的人口统计学、症状、首次实验室结果、治疗方法和结局（住院 12 天内）数据。结果显示，症状出现至入院的中位时间随时间推移逐渐缩短（分别为 13、10 和 5 天，p<0.05）。C 组发热和双侧肺炎患者比例较 A 组和 B 组低。实验室结果显示，C 组白细胞、中性粒细胞和血小板计数、乳酸和 D-二聚体水平较低，而淋巴细胞、CD3 和 CD8 计数较高。此外，C 组较其他两组轻中度病例更多，重度病例更少。更重要的是，并发症发生率（分别为 18.5%、14.2%和 11.2%，p<0.05）和全因死亡率（分别为 11.7%、8.4%和 5.6%，p<0.05）随时间推移而降低。COVID-19 患者的临床特征和预后随时间而变化，在后期发现预后改善。
