Clinical Characteristics of SARS-CoV-2 Pneumonia Compared to Controls in Chinese Han Population

  1. Yang Xu
  2. Yi-rong Li
  3. Qiang Zeng
  4. Zhi-bing Lu
  5. Yong-zhe Li
  6. Wei Wu
  7. Sheng-yong Dong
  8. Gang Huang
  9. Xing-huan Wang

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Abstract

Background

In December 2019, novel coronavirus (SARS-CoV-2) infected pneumonia occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of SARS-CoV-2 pneumonia without comorbidities compared to normal controls in Chinese Han population is limited. Our objective is to describe the epidemiological and clinical characteristics of SARS-CoV-2 pneumonia without comorbidities compared to normal controls in the Chinese Han population.

Methods

Retrospective, multi-center case series of the 69 consecutive hospitalized patients with confirmed SARS-CoV-2 pneumonia, from February 7 to February 28, 2020; final date of follow-up was February 29, 2020.

Results

The study population included 69 hospitalized patients with confirmed SARS-CoV-2 pneumonia without comorbidities and 14,117 normal controls. 50.7% patients were male and 49.3% were female; 1.5% patients were asymptomatic cases, 63.8% patients were mild cases, and 36.2% patients were severe or critical cases. Compared with mild patients (n=44), severe or critical patients (n=25) were significantly older (median age, 67 years [IQR, 58-79] vs. 49 years [IQR, 36-60]; p <0.01). Fever was present in 98.6% of the patients. The second most common symptom was cough (62.3%), fatigue (58.0%), sputum (39.1%), and headache (33.3%). The median incubation period was 4 days (IQR, 2 to 7). Leukocyte count was 74.1% of normal controls and lymphocyte count was 45.9% of normal controls. The phenomenon of lymphocyte depletion (PLD) observed in severe or critical cases in 100%. Levels of lactate dehydrogenase, D-dimer, procalcitonin, and interleukin-6 were showed significant differences between mild and severe or critical cases. Chest computed tomographic scans showed bilateral patchy patterns (49.3%), local patchy shadowing (29.0%), and ground glass opacity (21.7%). 7.3% patients were diagnosed ARDS, 7.3% patients were diagnosed acute cardiac injury (troponin I >28 pg/mL) and 4.4% patients were diagnosed fungal infections or shock. 4.3% patients have been discharged; 1.5% patient had died; 1.5% patient had recovery.

Conclusions

In this multicenter case series of 69 patients without comorbidities, the full spectrum of asymptomatic, mild, severe, and critical cases is described. 50.7% patients were male and 49.3% were female; 1.5% patients were asymptomatic cases, 63.8% patients were mild cases, and 36.2% patients were severe or critical cases. 4.3% patients have been discharged; 1.5% patient had died; 1.5% patient had recovery. Among the 25 patients with severe or critical disease, 12.0% patients were underwent non-invasive mechanical ventilation, 8.0% patients underwent invasive mechanical ventilation, and 4.0% patients died.

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  1. ScreenIT

    SciScore for 10.1101/2020.03.08.20031658: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: This case series was approved by the institutional ethics board of Zhongnan Hospital of Wuhan University (No. 2020020) and Peking Union Medical College Hospital (ZS-1830).
    Consent: Written informed consent was waived due to the rapid emergence of this infectious disease.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using SPSS (Statistical Package for the Social Sciences) version 13.0 software (SPSS Inc).
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)
    SPSS
    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:
    This study has several limitations. First, only 69 cases were included. However, this report is the first multicenter study of SARS-CoV-2 infection without comorbidities and 14,117 normal controls were analyzed. Through this report, a larger multicenter cohort study can be introduced in the future. Second, among the 69 cases, most patients are still hospitalized at the time of manuscript submission. Therefore, it is difficult to assess all risk factors for poor outcome. Third, the assay of IgG and IgM antibodies to SARS-CoV-2 in serum is not available yet. Fourth, the clinical characteristics of SARS-CoV-2 pneumonia of 2019 in Wuhan and SARS-CoV pneumonia of 2003 in Beijing should be compared and studied.20 Fifth, the pathophysiology of SARS-CoV-2 infecting the lungs and intestines through the ACE2 receptor and TMPRSS2 or the acquired immunodeficiency (CD4 cells below 200 cells/mm3) associated with COVID-19 (the severe or critical cases) seen in some patients directly or indirectly caused by SARS-CoV-2 is not understood, and further research and observation are needed.

    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 10.1101/2020.03.08.20031658v1 on medRxiv