Yang Ruhao, Wei Jie, Hu Weihua, Xiong Jun, Liu Menglin, Hu Ke
Department of Emergency, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China.
Ann Palliat Med. 2021 Apr;10(4):4201-4213. doi: 10.21037/apm-20-2222. Epub 2021 Mar 23.
Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) continues to make a deadly impact on human life all over the world. Therefore, we aimed to analyze the changes in clinical characteristics of coronavirus disease 2019 (COVID-19) patients over time.
We recruited 896 patients who were admitted to the Renmin Hospital of Wuhan University between 30th January 2020 and 16st March 2020. We conducted a retrospective study collecting clinical characteristics, radiologic and laboratory findings, treatments administered, and clinical outcomes in the patients. The data collected were compared between patients with onset of illness in January 2020 and patients with onset of illness in February 2020, in Wuhan, China. Categorical data and non-normally distributed continuous data were examined by the χ2 test and the Mann-Whitney-Wilcoxon test respectively, and the Kaplan-Meier plot was used to analyze survival data. Univariate and multivariate logistic regression methods were used to explore the risk factors associated with in-hospital death.
A total of 896 patients were enrolled; the median age was 60 (range, 47-69) years, 685 (76.5%) were categorized into group A (patients with onset of illness in January 2020), and 211 (23.5%) were categorized into group B (patients with onset of illness in February 2020). Compared with group B, group A had a higher incidence of fever (P<0.001), and a lower rate of asymptomatic individuals (P<0.001). Group A patients had a higher incidence of neutrophilia (P=0.043), an elevated D-dimer (P<0.001), and an increased lactate dehydrogenase (LDH) (P=0.002), but a lower incidence of a normal computed tomography (CT) scan (P=0.001). CD3 cell counts (P=0.015) and CD4 cell counts (P=0.04) were significantly reduced in group A patients. Critically ill patients were less frequent (P=0.005) and patients with milder disease were more common (P=0.001) in group B. The fatality rate was significantly less in group B patients (P=0.028). Multivariate regression indicated that older age (odds ratio 1.086, 95% CI: 1.061-1.111, per year increase; P<0.001) increased the risk of in-hospital death. Female sex (odds ratio 0.523, 95% CI: 0.316-0.865; P=0.012) and being in group B (odds ratio 0.423, 95% CI: 0.212-0.844; P=0.015) significantly decreased the risk of in-hospital death.
The condition of patients with onset of illness in January was more serious than that of patients with onset of illness in February 2020. The time of onset of illness was an independent risk factor for in-hospital death comparing January and February 2020. Changing pathogenicity of SARS-CoV-2 and improved healthcare may have contributed to the results, however, more basic research is required to support this hypothesis.
严重急性呼吸综合征相关冠状病毒2（SARS-CoV-2）继续在全球范围内对人类生命造成致命影响。因此，我们旨在分析2019冠状病毒病（COVID-19）患者临床特征随时间的变化。
我们招募了2020年1月30日至2020年3月16日期间入住武汉大学人民医院的896例患者。我们进行了一项回顾性研究，收集患者的临床特征、影像学和实验室检查结果、所接受的治疗以及临床结局。对中国武汉2020年1月发病的患者和2020年2月发病的患者收集的数据进行比较。分类数据和非正态分布的连续数据分别采用χ2检验和Mann-Whitney-Wilcoxon检验进行分析，并用Kaplan-Meier曲线分析生存数据。采用单因素和多因素逻辑回归方法探讨与院内死亡相关的危险因素。
共纳入896例患者；中位年龄为60岁（范围47 - 69岁），685例（76.5%）被归入A组（2020年1月发病的患者），211例（23.5%）被归入B组（2020年2月发病的患者）。与B组相比，A组发热发生率更高（P<0.001），无症状个体比例更低（P<0.001）。A组患者中性粒细胞增多症发生率更高（P = 0.043），D-二聚体升高（P<0.001），乳酸脱氢酶（LDH）升高（P = 0.002），但计算机断层扫描（CT）正常的发生率更低（P = 0.001）。A组患者CD3细胞计数（P = 0.015）和CD4细胞计数（P = 0.04）显著降低。B组重症患者较少（P = 0.005），轻症患者较多（P = 0.001）。B组患者病死率显著较低（P = 0.028）。多因素回归表明，年龄较大（比值比1.086，95%置信区间：1.061 - 1.111，每年增加；P<0.001）会增加院内死亡风险。女性（比值比0.523，95%置信区间：0.316 - 0.865；P = 0.012）和B组（比值比0.423，95%置信区间：0.212 - 0.844；P = 0.015）显著降低院内死亡风险。
2020年1月发病患者的病情比2020年2月发病患者更严重。比较2020年1月和2月，发病时间是院内死亡的独立危险因素。SARS-CoV-2致病性的变化和医疗保健的改善可能导致了这一结果，然而，需要更多基础研究来支持这一假设。
