Clinical Characteristics of Coronavirus Disease 2019 in China - NEJM

Bron: 28-2-2020: https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
By: Guan et al., for the China Medical Treatment Expert Group for Covid-19

Aim
Description of clinical characteristics of Covid-19 in a selected cohort of 1099 hospitalized patients throughout China

Key

• Most common symptoms: fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%).
• Admission to ICU: 5.0%
• Use of mechanical ventilation: 2.3%
• Mortality: 1.4% 

Summary

• Flow diagram: Of 7736 patients who had been hospitalized at 552 sites as of January 29, 2020, researchers obtained data for 1099 patients (14.2%).

• Included hospitals: including 29.7% of the 1856 designated hospitals where patients with Covid-19 could be admitted in 30 provinces across China. Largest number of patients (n=132) had been admitted to Wuhan Jinyintan Hospital.
• Median age: 47 years (IQR 35-58).
• 0.9% of the patients were <15 years of age
• Female: 41.9%
• Contact history: 483 patients (43.9%) were residents of Wuhan. Among non-residents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. 25.9% of nonresidents had neither visited the city nor had contact with Wuhan residents. 1.9% had history of direct contact with wildlife. 3.5% were health care workers.
• Co-morbidities: 23.7% had at least one coexisting illness (e.g. hypertension or COPD)
• Median incubation period: 4 days (IQR 2-7).
• Most common symptoms: fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%).  
• Severity: Severe/non-severe according to the American Thoracic Society guidelines for community-acquired pneumonia. Non-severe: 926 patients (84.2%) and severe in 173 patients (15.7%). Severe patients: older, more co-morbidities, higher change of primary composite end-point.
• Laboratory: On admission, lymphocytopenia was present in 83.2%, thrombocytopenia in 36.2%, and leukopenia in 33.7% of the patients.
• Radiology: At time of admission 975 CT scans were performed. Ground-glass opacity was the most common radiologic finding on chest CT (56.4%). No radiographic or CT abnormality was found in 157/877 patients (17.9%) with non-severe disease and in 5/173 patients (2.9%) with severe disease.  
• Primary composite end point was admission to ICU, the use of mechanical ventilation, or death. The endpoint occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died.
• Treatment: 58.0% received intravenous antibiotic therapy, 35.8% received oseltamivir therapy; oxygen therapy was administered in 41.3% and mechanical ventilation in 6.1%.
• Median duration of hospitalization: 12.0 days.