Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China
Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China
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DOI：
10.1183/13993003.00562-2020
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发表时间：
2020-06-01
影响因子：
24.3
通讯作者：
He, Jian-xing
中科院分区：
文献类型：
--
作者：
Liang, Wen-hua;Guan, Wei-jie;He, Jian-xing
背景资料：在2019冠状病毒病（COVID-19）爆发期间，观察到湖北省治疗的患者的疾病严重程度和死亡率与中国其他地区相比存在一致且显著的差异。我们试图比较湖北省内外接受治疗的患者的临床特征和结局，并探讨这些差异的潜在因素。方法：与国家卫生委员会合作，我们建立了一个回顾性队列，研究中国住院的COVID-19病例。比较湖北境内和境外患者的临床特征、严重事件和死亡率以及至危重病（有创通气或重症监护室入院或死亡）的时间。武汉相关曝光的影响（一个假定的关键因素，推动了湖北省的严重情况，因为武汉是震中，以及湖北省的行政中心）和症状发作和入院之间的时间对预后也进行了测定。在数据截止日期（2020年1月31日），从31个省级行政区的575家医院收集了1590例病例（核心队列）。重症病例和死亡率分别为16.0%和3.2%。湖北患者（主要是武汉相关暴露，647人中有597人（92.3%）年龄较大）（平均年龄49.7岁对44.9岁），合并症病例更多（32.9%对19.7%），更高的症状负担，异常的放射学表现，特别是，与湖北以外的患者相比，从症状发作到入院的等待时间更长（5.7天对4.5天）。校正年龄和合并症后，湖北地区患者（重度事件发生率23.0% vs 11.1%，死亡率7.3% vs 0.3%，危重病HR（95%CI）1.59（1.052.41））的预后比湖北以外的患者差。然而，在湖北以外的患者中，从症状发作到住院的持续时间（平均4.4 vs 4.7天）和预后（HR（95%）0.84（0.40-1.80））在有或无武汉相关暴露的患者之间相似。在总体人群中，等待时间，但既没有在湖北治疗，也没有武汉相关的暴露，仍然是一个独立的预后因素（HR（95%）1.05（1.01-1.08））。结论：有更多的严重病例和更差的结果为COVID-19患者在湖北治疗，这可能是由于在震中症状发作到住院的时间延长。未来的研究，以确定延迟住院的原因是必要的。
Background: During the outbreak of coronavirus disease 2019 (COVID-19), consistent and considerable differences in disease severity and mortality rate of patients treated in Hubei province compared to those in other parts of China have been observed. We sought to compare the clinical characteristics and outcomes of patients being treated inside and outside Hubei province, and explore the factors underlying these differences.Methods: Collaborating with the National Health Commission, we established a retrospective cohort to study hospitalised COVID-19 cases in China. Clinical characteristics, the rate of severe events and deaths, and the time to critical illness (invasive ventilation or intensive care unit admission or death) were compared between patients within and outside Hubei. The impact of Wuhan-related exposure (a presumed key factor that drove the severe situation in Hubei, as Wuhan is the epicentre as well the administrative centre of Hubei province) and the duration between symptom onset and admission on prognosis were also determined.Results: At the data cut-off (31 January 2020), 1590 cases from 575 hospitals in 31 provincial administrative regions were collected (core cohort). The overall rate of severe cases and mortality was 16.0% and 3.2%, respectively. Patients in Hubei ( predominantly with Wuhan-related exposure, 597 (92.3%) out of 647) were older (mean age 49.7 versus 44.9 years), had more cases with comorbidity (32.9% versus 19.7%), higher symptomatic burden, abnormal radiologic manifestations and, especially, a longer waiting time between symptom onset and admission (5.7 versus 4.5 days) compared with patients outside Hubei. Patients in Hubei (severe event rate 23.0% versus 11.1%, death rate 7.3% versus 0.3%, HR (95% CI) for critical illness 1.59 (1.052.41)) have a poorer prognosis compared with patients outside Hubei after adjusting for age and comorbidity. However, among patients outside Hubei, the duration from symptom onset to hospitalisation (mean 4.4 versus 4.7 days) and prognosis (HR (95%) 0.84 (0.40-1.80)) were similar between patients with or without Wuhan-related exposure. In the overall population, the waiting time, but neither treated in Hubei nor Wuhan-related exposure, remained an independent prognostic factor (HR (95%) 1.05 (1.01-1.08)).Conclusion: There were more severe cases and poorer outcomes for COVID-19 patients treated in Hubei, which might be attributed to the prolonged duration of symptom onset to hospitalisation in the epicentre. Future studies to determine the reason for delaying hospitalisation are warranted.