Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China
Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China
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中国武汉市 138 例 2019 新型冠状病毒感染肺炎住院患者的临床特征。
DOI：
10.1001/jama.2020.1585
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发表时间：
2020-03-17
影响因子：
120.7
通讯作者：
Peng, Zhiyong
中科院分区：
文献类型：
--
作者：
Wang, Dawei;Hu, Bo;Peng, Zhiyong
该单中心病例系列描述了138名因2019年新型冠状病毒住院的患者的人口统计学、症状、实验室和影像学检查结果、治疗和临床病程2019-nCoV感染的肺炎（NCIP）在中国武汉爆发，在许多情况下，突出了假定的人传人医院相关传播。重要性2019年12月，中国武汉发生新型冠状病毒（2019-nCoV）感染的肺炎（NCIP）。病例数量迅速增加，但有关受影响患者临床特征的信息有限。目的探讨非典型肺炎（NCIP）的流行病学和临床特点。设计、设置和参与者回顾性、单中心病例系列研究，纳入了2020年1月1日至1月28日在中国武汉市武汉大学中南医院确诊的138例连续住院患者;最终随访日期为2020年2月3日。暴露记录NCIP。主要结果和测量流行病学、人口统计学、临床、实验室、放射学和治疗数据被收集和分析。比较危重患者和非危重患者的结局。如果同一病房的一群卫生专业人员或住院患者受到感染，并且可以追踪到可能的感染源，则怀疑与医院有关的传播。结果138例NCIP住院患者中，中位年龄为56岁（四分位距，42-68;范围，22-92岁），75例（54.3%）为男性。医院相关传播被怀疑是受影响的卫生专业人员（40 [29%]）和住院患者（17 [12.3%]）的假定感染机制。常见症状包括发热（136例[98.6%]）、疲乏（96例[69.6%]）和干咳（82例[59.4%]）。淋巴细胞（淋巴细胞计数，0.8 x 10（9）/L [四分位距{IQR}，0.6-1.1]）（70.3%），凝血酶原时间延长（13.0秒[IQR，12.3-13.7]），55例患者（39.9%）乳酸脱氢酶升高（261 U/L [IQR，182-403]）。胸部计算机断层扫描显示所有患者的双肺斑片状阴影或磨玻璃样阴影。大多数患者接受了抗病毒治疗（奥司他韦，124例[89.9%]），许多患者接受了抗菌治疗（阿氟沙星，89例[64.4%];头孢曲松，34例[24.6%];阿奇霉素，25例[18.1%]）和糖皮质激素治疗（62例[44.9%]）。36例患者（26.1%）因并发症转入重症监护室（ICU），包括急性呼吸窘迫综合征（22例[61.1%]）、心律失常（16例[44.4%]）和休克（11例[30.6%]）。从首发症状到呼吸困难的中位时间为5.0天，到入院的中位时间为7.0天，到ARDS的中位时间为8.0天。与未在ICU治疗的患者（n = 102）相比，在ICU治疗的患者（n = 36）年龄较大（中位年龄，66岁vs 51岁），更可能有潜在的合并症（26 [72.2%] vs 38 [37.3%]），更可能发生呼吸困难（23 [63.9%] vs 20 [19.6%]）和厌食症（24 [66.7%] vs 31 [30.4%]）。在ICU的36例患者中，4例（11.1%）接受高流量氧疗，15例（41.7%）接受无创通气，17例（47.2%）接受有创通气（4例转为体外膜肺氧合）。截至2月3日，47例患者（34.1%）出院，6例死亡（总死亡率4.3%），但其余患者仍在住院治疗。在存活出院的患者（n = 47）中，中位住院时间为10天（IQR，7.0-14.0）。结论和相关性在中国武汉138例确诊NCIP的住院患者的单中心病例系列中，41%的患者疑似2019-nCoV的医院相关传播，26%的患者接受ICU护理，死亡率为4.3%。问题2019年新型冠状病毒住院患者的临床特征是什么（2019-nCoV）感染的肺炎（NCIP）在中国武汉？结果在这个涉及138例NCIP患者的单中心病例系列中，26%的患者需要入住重症监护室，4.3%死亡。在41%的患者中怀疑2019-nCoV的假定人传人医院相关传播。在中国武汉的这一病例系列中，NCIP经常与假定的医院相关传播相关，26%的患者需要重症监护室治疗，死亡率为4.3%。
This single-center case series describes the demographics, symptoms, laboratory and imaging findings, treatment, and clinical course of 138 patients hospitalized with 2019 novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) in Wuhan, China, highlighting presumed human-to-human hospital-associated transmission in many cases.Importance In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited. Objective To describe the epidemiological and clinical characteristics of NCIP. Design, Setting, and Participants Retrospective, single-center case series of the 138 consecutive hospitalized patients with confirmed NCIP at Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 28, 2020; final date of follow-up was February 3, 2020. Exposures Documented NCIP. Main Outcomes and Measures Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. Presumed hospital-related transmission was suspected if a cluster of health professionals or hospitalized patients in the same wards became infected and a possible source of infection could be tracked. Results Of 138 hospitalized patients with NCIP, the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men. Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]). Common symptoms included fever (136 [98.6%]), fatigue (96 [69.6%]), and dry cough (82 [59.4%]). Lymphopenia (lymphocyte count, 0.8 x 10(9)/L [interquartile range {IQR}, 0.6-1.1]) occurred in 97 patients (70.3%), prolonged prothrombin time (13.0 seconds [IQR, 12.3-13.7]) in 80 patients (58%), and elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55 patients (39.9%). Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]). The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days. Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102), were older (median age, 66 years vs 51 years), were more likely to have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%) received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17 (47.2%) received invasive ventilation (4 were switched to extracorporeal membrane oxygenation). As of February 3, 47 patients (34.1%) were discharged and 6 died (overall mortality, 4.3%), but the remaining patients are still hospitalized. Among those discharged alive (n = 47), the median hospital stay was 10 days (IQR, 7.0-14.0). Conclusions and Relevance In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.Question What are the clinical characteristics of hospitalized patients with 2019 novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) in Wuhan, China? Findings In this single-center case series involving 138 patients with NCIP, 26% of patients required admission to the intensive care unit and 4.3% died. Presumed human-to-human hospital-associated transmission of 2019-nCoV was suspected in 41% of patients. Meaning In this case series in Wuhan, China, NCIP was frequently associated with presumed hospital-related transmission, 26% of patients required intensive care unit treatment, and mortality was 4.3%.