Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China
Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China
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中国武汉两家医院出院的 107 例新型冠状病毒 SARS-CoV-2 感染患者的临床病程和结果
DOI：
10.1186/s13054-020-02895-6
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发表时间：
2020-04-30
期刊：
影响因子：
15.1
通讯作者：
Peng, Zhiyong
中科院分区：
文献类型：
--
作者：
Wang, Dawei;Yin, Yimei;Peng, Zhiyong
背景于二零一九年十二月，中国武汉报告爆发2019冠状病毒病（COVID-19）疫情。有关COVID-19的临床过程和预后的信息没有得到充分描述。我们描述了COVID-19患者的临床病程和预后。方法回顾性病例系列，来自武汉大学中南医院和湖北省习水医院的COVID-19患者，截至2020年2月10日。收集流行病学、人口统计学和临床数据。比较存活者和非存活者的临床病程。结果共纳入107例COVID-19出院患者。2019冠状病毒病的临床过程呈现三阶段模式。发病后第1周，患者表现为发热、咳嗽、呼吸困难、淋巴细胞减少和放射学多叶肺浸润。在严重病例中，观察到血小板减少症、急性肾损伤、急性心肌损伤和成人呼吸窘迫综合征。在第2周期间，在轻度病例中，发热、咳嗽和全身症状开始消退，血小板计数升至正常范围，但淋巴细胞减少症持续存在。在严重病例中，白细胞增多、嗜中性粒细胞增多和多器官功能障碍恶化占主导地位。到第3周，除淋巴细胞减少症外，轻度病例已临床消退。然而，严重病例表现为持续性淋巴细胞减少、严重急性呼吸困难综合征、难治性休克、无尿性急性肾损伤、凝血功能障碍、血小板减少和死亡。年龄较大和男性是疾病预后不良的独立危险因素。结论发病后7-13 d是COVID-19病程的关键阶段。年龄和男性是COVID-19死亡的独立风险因素。
BackgroundIn December 2019, coronavirus disease 2019 (COVID-19) outbreak was reported from Wuhan, China. Information on the clinical course and prognosis of COVID-19 was not thoroughly described. We described the clinical courses and prognosis in COVID-19 patients.MethodsRetrospective case series of COVID-19 patients from Zhongnan Hospital of Wuhan University in Wuhan and Xishui Hospital, Hubei Province, China, up to February 10, 2020. Epidemiological, demographic, and clinical data were collected. The clinical course of survivors and non-survivors were compared. Risk factors for death were analyzed.ResultsA total of 107 discharged patients with COVID-19 were enrolled. The clinical course of COVID-19 presented as a tri-phasic pattern. Week 1 after illness onset was characterized by fever, cough, dyspnea, lymphopenia, and radiological multi-lobar pulmonary infiltrates. In severe cases, thrombocytopenia, acute kidney injury, acute myocardial injury, and adult respiratory distress syndrome were observed. During week 2, in mild cases, fever, cough, and systemic symptoms began to resolve and platelet count rose to normal range, but lymphopenia persisted. In severe cases, leukocytosis, neutrophilia, and deteriorating multi-organ dysfunction were dominant. By week 3, mild cases had clinically resolved except for lymphopenia. However, severe cases showed persistent lymphopenia, severe acute respiratory dyspnea syndrome, refractory shock, anuric acute kidney injury, coagulopathy, thrombocytopenia, and death. Older age and male sex were independent risk factors for poor outcome of the illness.ConclusionsA period of 7–13 days after illness onset is the critical stage in the COVID-19 course. Age and male gender were independent risk factors for death of COVID-19.