Differences of clinical and imaging findings in multiple generations of secondary COVID-19 infection in Xi’an, China

  1. Runqing Li
  2. Zhijie Jian
  3. Chao Jin
  4. Yan Wang
  5. Ting Liang
  6. Zhe Liu
  7. Huifang Zhao
  8. Zekun Wang
  9. Jie Zhou
  10. Lingxia Zeng
  11. Jian Yang

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Abstract

PURPOSE

In the global presence of secondary infections with the coronavirus disease 2019 (COVID-19), little is known about the transmission characteristics of COVID-19 outside Wuhan, China. We evaluated differences in clinic and radiologic findings of multiple generations of COVID-19 infection in Xi’an (Shaanxi, China) to provide more clues for the correct estimate of the disease.

METHODS

All COVID-19 infected patients reported in Xi’an up to 10 February 2020 were included for this analysis. Among these cases, clinical and chest CT data of 62 cases were obtained from three hospital in Xi’an. With this information, patients were grouped on basis of exposure history and transmission chains as first-generation, second-generation and third-generation patients. We described clinical characteristics and evaluated CT score/patterns in these COVID-19 cases.

RESULTS

There was a clear age differences in multiple generations with COVID-19 infection. Above two thirds of the second-generation (75.0%) and third-generation patients (77.8%) were aged ≥45 years while 40.0% of first-generation cases at this age ( p =0.001). More than half of second-generation patients (52.8%) and third-generation patients (55.6%) have comorbidities and is predominantly hypertensive (22.8% of second-generation vs. 27.8% of third-generation infections). The main exposure of second- and third-generation patients in Xi’an is family exposure (35.2%). For evaluation of CT findings of pulmonary involvement, the total CT score were 4.22±3.00 in first-generation group, 4.35±3.03 in second-generation group and 7.62±3.56 in third-generation group ( p <0.001). In all of three generations, the predominant pattern of abnormality observed was organizing pneumonia (65.5% in first-generation group, 61.5% in second-generation group and 71.4% in third-generation group). The average courses of the disease in third-generation infections has obviously extension (22.93±7.22 days of first-generation, 21.53±8.31 days of second-generation vs. 31.00±8.12 days of third-generation group, p =0.004). There were no significant differences of the pulmonary sequelae among three generation patients.

CONCLUSION

There is more serious pulmonary infection of COVID-19 pneumonia in second- and third-generation patients, which might be attribute to the elder age and comorbidity of these patients.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.23.20109496: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    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:
    The several limitations include in this study. First, the samples we investigated is small, particularly for patients defined as sever/critical. As more data become available in other locations, it will be possible to promote this investigation. Second, we compared epidemiological, demographic, clinical and radiological characteristics in the multiple generation infections in Xi’an, which does not account for potential geographic discrepancy. In conclusion, the government interventions against COVID-19 have been successfully used to stop the epidemic in Xi’an. Combining clinical features and chest CT patterns, our study demonstrated similar changes in three generations of cases. Older people with underlying medical conditions are at higher risk of getting secondary infections and longer duration. Measures for public and individuals to reduce or prevent transmission should be reinforced in populations at risk in the next stage. Declarations of interests: The authors of this study declare that they have no competing interests.

    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.
    • No funding statement was detected.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.05.23.20109496v1 on medRxiv