Clinical Features of Patients Infected with the 2019 Novel Coronavirus (COVID-19) in Shanghai, China

  1. Min Cao
  2. Dandan Zhang
  3. Youhua Wang
  4. Yunfei Lu
  5. Xiangdong Zhu
  6. Ying Li
  7. Honghao Xue
  8. Yunxiao Lin
  9. Min Zhang
  10. Yiguo Sun
  11. Zongguo Yang
  12. Jia Shi
  13. Yi Wang
  14. Chang Zhou
  15. Yidan Dong
  16. Longping Peng
  17. Ping Liu
  18. Steven M. Dudek
  19. Zhen Xiao
  20. Hongzhou Lu

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Abstract

Background

Since mid-December 2019, a cluster of pneumonia-like diseases caused by a novel coronavirus, now designated COVID-19 by the WHO, emerged in Wuhan city and rapidly spread throughout China. Here we identify the clinical characteristics of COVID-19 in a cohort of patients in Shanghai.

Methods

Cases were confirmed by real-time RT-PCR and were analysed for demographic, clinical, laboratory and radiological features.

Results

Of 198 patients, the median duration from disease onset to hospital admission was 4 days. The mean age of the patients was 50.1 years, and 51.0% patients were male. The most common symptom was fever. Less than half of the patients presented with respiratory systems including cough, sputum production, itchy or sore throat, shortness of breath, and chest congestion. 5.6% patients had diarrhoea. On admission, T lymphocytes were decreased in 45.8% patients. Ground glass opacity was the most common radiological finding on chest computed tomography. 9.6% were admitted to the ICU because of the development of organ dysfunction. Compared with patients not treated in ICU, patients treated in the ICU were older, had longer waiting time to admission, fever over 38.5° C, dyspnoea, reduced T lymphocytes, elevated neutrophils and organ failure.

Conclusions

In this single centre cohort of COVID-19 patients, the most common symptom was fever, and the most common laboratory abnormality was decreased blood T cell counts. Older age, male, fever over 38.5°C, symptoms of dyspnoea, and underlying comorbidity, were the risk factors most associated with severity of disease.

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  1. ScreenIT

    SciScore for 10.1101/2020.03.04.20030395: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Written informed consent was waived in light of the urgent need to collect clinical data.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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, although we obtained data from the initial 198 patients with laboratory-confirmed COVID-19 in Shanghai, the cohort is still relatively small. More patients need to be analysed to provide a comprehensive and precise description of the spectrum of disease associated with this infection. Secondly, our study reports primarily baseline results from patients upon hospital admission, and more longitudinal data regarding disease progression and clinical outcomes will require further collection and study. Despite these limitations, our study provides data from the first large cohort outside Wuhan and adds important laboratory information to the rapidly accumulating body of information about COVID-19. These results will assist in multi-centre monitoring of the disease. In conclusion, COVID-19 affects a wide-range of patients, from youth to the elderly. Fever is consistently the most common symptom of onset, but multiple other clinical manifestations occur, including a spectrum form T cell deficiency to symptoms of digestive system involvement. Older age, male, fever over 38.5°C, symptom of dyspnoea, the presence of underlying cardiovascular disease, and longer waiting period from onset of symptom to hospital admission are risk factors associated with the severity of disease.

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.03.04.20030395v1 on medRxiv