Department of Public Health, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Infect Public Health. 2020 Sep;13(9):1202-1209. doi: 10.1016/j.jiph.2020.07.002. Epub 2020 Jul 17.
The COVID-19 outbreak in late December 2019 has quickly emerged into pandemic in 2020. We aimed to describe the epidemiology and clinical characteristics of hospitalized COVID-19 patients, and to investigate the potential risk factors for COVID-19 severity.
1663 hospitalized patients with laboratory-confirmed diagnosed COVID-19 from Tongji Hospital between January 14, 2020, and February 28, 2020 were included in the present study. Demographic information, exposure history, medical history, comorbidities, signs and symptoms, chest computed tomography (CT) scanning, severity of COVID-19 and laboratory findings on admission were collected from electronic medical records. Multivariable logistic regression was used to explore the association between potential risk factors with COVID-19 severity.
In the present study, the majority (79%) of 1663 COVID-19 patients were aged over 50 years old. A total of 2.8% were medical staff, and an exposure history of Huanan seafood market was document in 0.7%, and 7.4% were family infection. Fever (85.8%), cough (36.0%), fatigue (23.6%) and chest tightness (11.9%) were the most common symptoms in COVID-19 patients. As of February 28, 2020, of the 1663 patients included in this study, 26.0% were discharged, 10.2% were died, and 63.8% remained hospitalized. More than 1/3 of the patients had at least one comorbidity. Most (99.8%) patients had abnormal results Chest CT, and the most common manifestations of chest CT were local patchy shadowing (70.7%) and ground-glass opacity (44.8%). On admission, lymphocytopenia was present in 51.1% of the patients, mononucleosis in 26.6%, and erythrocytopenia in 61.3%. Most of the patients had increased levels of C-reactive protein (80.4%) and D-dimer (64.4%). Compared with non-severe patients, severe patients had more obvious abnormal laboratory results related to inflammation, coagulation disorders, liver and kidney damage (all P < 0.05). Older age (OR = 2.37, 95% CI: 1.47-3.83), leukocytosis (OR = 2.37, 95% CI: 1.47-3.83), and increased creatine kinase (OR = 2.37, 95% CI: 1.47-3.83) on admission were significantly associated with COVID-19 severity.
Timely medical treatment and clear diagnosis after the onset might be beneficial to control the condition of COVID-19. Severe patients were more likely to be to be elder, and tended to have higher proportion of comorbidities and more prominent laboratory abnormalities. Older age, leukocytosis, and increased creatine kinase might help clinicians to identify severe patients with COVID-19.
2019 年 12 月下旬,COVID-19 疫情迅速在 2020 年爆发为大流行。我们旨在描述住院 COVID-19 患者的流行病学和临床特征,并探讨 COVID-19 严重程度的潜在危险因素。
本研究纳入了 2020 年 1 月 14 日至 2 月 28 日期间,在同济医院确诊为 COVID-19 的 1663 例住院患者。从电子病历中收集了人口统计学信息、暴露史、病史、合并症、体征和症状、胸部计算机断层扫描(CT)、COVID-19 严重程度和入院时的实验室结果。多变量逻辑回归用于探索潜在危险因素与 COVID-19 严重程度之间的关联。
在本研究中,1663 例 COVID-19 患者中,大多数(79%)年龄超过 50 岁。共有 2.8%为医务人员,有 0.7%的患者有华南海鲜市场暴露史,7.4%为家庭感染。发热(85.8%)、咳嗽(36.0%)、乏力(23.6%)和胸闷(11.9%)是 COVID-19 患者最常见的症状。截至 2020 年 2 月 28 日,本研究纳入的 1663 例患者中,26.0%已出院,10.2%死亡,63.8%仍住院。超过 1/3 的患者有至少一种合并症。大多数(99.8%)患者的胸部 CT 检查结果异常,胸部 CT 最常见的表现为局部斑片状阴影(70.7%)和磨玻璃样混浊(44.8%)。入院时,51.1%的患者出现淋巴细胞减少,26.6%的患者出现单核细胞增多,61.3%的患者出现红细胞减少。大多数患者的 C-反应蛋白(80.4%)和 D-二聚体(64.4%)水平升高。与非重症患者相比,重症患者的炎症、凝血障碍、肝肾功能损害相关的实验室异常更明显(均 P<0.05)。高龄(OR=2.37,95%CI:1.47-3.83)、白细胞增多(OR=2.37,95%CI:1.47-3.83)和入院时肌酸激酶升高(OR=2.37,95%CI:1.47-3.83)与 COVID-19 严重程度显著相关。
发病后及时就医和明确诊断可能有助于控制 COVID-19 病情。重症患者更可能年龄较大,且更有可能有更高的合并症比例和更明显的实验室异常。高龄、白细胞增多和肌酸激酶升高可能有助于临床医生识别 COVID-19 重症患者。