Epidemiological and clinical features of COVID-19 patients with and without pneumonia in Beijing, China

  1. Penghui Yang
  2. Yibo Ding
  3. Zhe Xu
  4. Rui Pu
  5. Ping Li
  6. Jin Yan
  7. Jiluo Liu
  8. Fanping Meng
  9. Lei Huang
  10. Lei Shi
  11. Tianjun Jiang
  12. Enqiang Qin
  13. Min Zhao
  14. Dawei Zhang
  15. Peng Zhao
  16. Lingxiang Yu
  17. Zhaohai Wang
  18. Zhixian Hong
  19. Zhaohui Xiao
  20. Qing Xi
  21. Dexi Zhao
  22. Peng Yu
  23. Caizhong Zhu
  24. Zhu Chen
  25. Shaogeng Zhang
  26. Junsheng Ji
  27. Guangwen Cao
  28. Fusheng Wang

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Abstract

Background

SARS-CoV-2-caused coronavirus disease (COVID-19) is posing a large casualty. The features of COVID-19 patients with and without pneumonia, SARS-CoV-2 transmissibility in asymptomatic carriers, and factors predicting disease progression remain unknown.

Methods

We collected information on clinical characteristics, exposure history, and laboratory examinations of all laboratory-confirmed COVID-19 patients admitted to PLA General Hospital. Cox regression analysis was applied to identify prognostic factors. The last follow-up was February 18, 2020.

Results

We characterized 55 consecutive COVID-19 patients. The mean incubation was 8.42 (95% confidence interval [CI], 6.55-10.29) days. The mean SARS-CoV-2-positive duration from first positive test to conversion was 9.71 (95%CI, 8.21-11.22) days. COVID-19 course was approximately 2 weeks. Asymptomatic carriers might transmit SARS-CoV-2. Compared to patients without pneumonia, those with pneumonia were 15 years older and had a higher rate of hypertension, higher frequencies of having a fever and cough, and higher levels of interleukin-6 (14.61 vs. 8.06pg/mL, P=0.040), B lymphocyte proportion (13.0% vs.10.0%, P=0.024), low account (<190/µL) of CD8 + T cells (33.3% vs. 0, P=0.019). Multivariate Cox regression analysis indicated that circulating interleukin-6 and lactate independently predicted COVID-19 progression, with a hazard ratio (95%CI) of 1.052 (1.000-1.107) and 1.082 (1.013-1.155), respectively. During disease course, T lymphocytes were generally lower, neutrophils higher, in pneumonia patients than in pneumonia-free patients. CD8 + lymphocytes did not increase at the 20 th days after illness onset.

Conclusion

The epidemiological features are important for COVID-19 prophylaxis. Circulating interleukin-6 and lactate are independent prognostic factors. CD8 + T cell exhaustion might be critical in the development of COVID-19.

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    SciScore for 10.1101/2020.02.28.20028068: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Enrollment and diagnosis: This case series was approved by the institutional ethics board of Fifth Medical Center of PLA General Hospital, with oral informed consents.
    Consent: Enrollment and diagnosis: This case series was approved by the institutional ethics board of Fifth Medical Center of PLA General Hospital, with oral informed consents.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Above statistical analyses were two-sided and performed using SPSS (Statistical Package for the Social Sciences) version 21.0 software.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, the effect of antiviral treatment was not evaluated due to lack of controls. Second, the family members of patient B’s sister were not examined for SARS-CoV-2, because they left when we performed this study. Third, half patients are still hospitalized. The disease course of severe patients might be prolonged by therapeutic regimens including corticosteroids.28 Finally, we characterized the epidemiological features including the incubation period, time to RT-PCR conversion of SARS-CoV-2, COVID-19 course, and the transmissibility SARS-CoV-2 in asymptomatic carriers. Old age, hypertension, interleukin-6, and CD8+ T cell exhaustion were significantly associated with the development of pneumonia. Circulating interleukin-6 and lactate independently predicted COVID-19 progression. CD8+ T cell exhaustion might be important in COVID-19 progression. This study not only elucidates some mechanisms of COVID-19 progression, but also provides epidemiological evidence to prevent COVID-19 epidemic outside the outbreak zone.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.02.28.20028068 on medRxiv