Clinical characteristics of imported and second-generation COVID-19 cases outside Wuhan, China: A multicenter retrospective study

  1. Puyu Shi
  2. Guoxia Ren
  3. Jun Yang
  4. Zhiqiang Li
  5. Shujiao Deng
  6. Miao Li
  7. Shasha Wang
  8. Xiaofeng Xu
  9. Fuping Chen
  10. Yuanjun Li
  11. Chunyan Li
  12. Xiaohua Yang
  13. Zhaofeng xie
  14. Zhengxia Wu
  15. Mingwei chen

Reviewed by

Read the full article

Discuss this preprint

Start a discussion What are Sciety discussions?

Listed in

Log in to save this article

Abstract

Background

The mortality of COVID-19 differs between countries and regions. By now, reports on COVID-19 are largely focused on first-generation cases. This study aimed to clarify the clinical characteristics of imported and second-generation cases.

Methods

This retrospective, multicenter cohort study included 134 confirmed COVID-19 cases from 9 cities outside Wuhan. Epidemiological, clinical and outcome data were extracted from medical records and were compared between severe and non-severe cases. We further profiled the dynamic laboratory findings of some patients.

Results

34.3% of the 134 patients were severe cases, and 11.2% had complications. As of March 7, 2020, 91.8% patients were discharged and one patient (0.7%) died. The median age was 46 years. The median interval from symptom onset to hospital admission was 4.5 (IQR 3-7) days. The median lymphocyte count was 1.1×10 9 /L. Age, lymphocyte count, CRP, ESR, DBIL, LDH, HBDH showed difference between severe and no-severe cases (all P<0.05). Baseline lymphocyte count was higher in the survived patients than in the non-survivor case, and it increased as the condition improved, but declined sharply when death occurred. The IL-6 level displayed a downtrend in survivors, but rose very high in the death case. Pulmonary fibrosis was found on later chest CT images in 51.5% of the pneumonia cases.

Conclusion

Imported and second-generation cases outside Wuhan had a better prognosis than initial cases in Wuhan. Lymphocyte count and IL-6 level could be used for evaluating prognosis. Pulmonary fibrosis as the sequelae of COVID-19 should be taken into account.

Summary

Imported and second-generation cases manifested less complications, lower fatality, and higher discharge rate than initial cases, which may be related to the shorter interval from symptom onset to hospital admission, younger age, and higher lymphocyte count of the imported and second-generation patients. Lymphocyte count and IL-6 level could be used as indicators for evaluating prognosis. Pulmonary fibrosis was found in later chest CT images in more than half of the pneumonia cases and should be taken into account.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.04.19.20071472: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Because of the urgent need to collect data regarding this emerging pathogen, requirement for informed consent was waived.
    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 with SPSS software, version 23.0.
    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:
    Limitations of study: This study has some limitations. First, as only COVID patients in Shaanxi were recruited, our conclusions need to be further verified by recruiting larger number of cases of other provinces or cities, outside Wuhan. Second, there were 2 critically ill cases with 1 non-survivor in our study, thus dynamic observations of laboratory parameters between non-survivor and survivor, recovered cases and critically ill cases were just descriptive analysis. Larger number of critically ill cases are needed to verify our observation.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04257656TerminatedA Trial of Remdesivir in Adults With Severe COVID-19
    NCT04257656TerminatedA Trial of Remdesivir in Adults With Severe COVID-19
    NCT04252664SuspendedA Trial of Remdesivir in Adults With Mild and Moderate COVID…
    NCT04252664SuspendedA Trial of Remdesivir in Adults With Mild and Moderate COVID…

    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 10.1101/2020.04.19.20071472 on medRxiv
  3. Version published to 10.1017/s0950268820002332