Clinical Characteristics of COVID-19: Clinical Dynamics of Mild Severe Acute Respiratory Syndrome Coronavirus 2 Infection Detected by Early Active Surveillance
Clinical Characteristics of COVID-19: Clinical Dynamics of Mild Severe Acute Respiratory Syndrome Coronavirus 2 Infection Detected by Early Active Surveillance
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DOI：
10.3346/jkms.2020.35.e297
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发表时间：
2020-08-17
影响因子：
4.5
通讯作者：
Park, Sang-Won
中科院分区：
文献类型：
--
作者：
Suh, Hyeon Jeong;Kim, Deok Hee;Park, Sang-Won
背景资料：关于在疾病早期诊断的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的表现特征和动态临床变化的信息有限。本研究是韩国11家医院收治的2019年冠状病毒病（COVID-19）患者的病例系列。方法：纳入了2020年2月20日至4月30日期间最终出院的患者，这些患者通过主动监测呼吸道标本的聚合酶链反应（PCR）检测阳性，确诊为SARS-CoV-2感染。入院时根据需氧量和序贯器官衰竭评估评分将患者分为轻度组和非轻度组，对轻度组进行随访，并将其分为非加重组和加重组。结果：共入组161例SARS-CoV 2感染患者。在136例轻度组患者中，11.7%的患者在住院期间发生了临床加重，但入院时没有预测其加重的初始临床参数。发热（OR 4.56）、血小板减少（OR 12.87）、发热（OR 27.22）、乳酸脱氢酶（LDH）> 300 U/L（OR 18.35）、CRP > 1 mg/dL（OR 11.31）分别在第1、2、3、4个5天显著提示病情加重。PCR阳性持续fora中位数为22天和32天后发病的非加重和加重groups.Conclusion：老年与早期严重的表现。无症状或轻度患者的临床恶化最初无法预测，但在临床过程中通过发热和几种实验室标志物预示。
Background: There is limited information describing the presenting characteristics and dynamic clinical changes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosed in the early phase of illness. This study is a case series of patients with coronavirus disease 2019 (COVID-19) admitted to 11 hospitals in Korea.Methods: Patients with confirmed SARS-CoV-2 infection by positive polymerase chain reaction (PCR) testing of respiratory specimens by active surveillance that were finally discharged between February 20 and April 30, 2020 were included. Patients were classified into mild and non-mild groups on initial admission according to oxygen demand and Sequential Organ Failure Assessment score, and the mild group was followed up and subgrouped into non-aggravation and aggravation groups.Results: A total of 161 patients with SARS-CoV2 infection were enrolled. Among the mild group of 136 patients, 11.7% of patients experienced clinical aggravation during hospitalization, but there was no initial clinical parameter on admission predicting their aggravation. Fever (odds ratio [OR], 4.56), thrombocytopenia (OR, 12.87), fever (OR, 27.22) and lactate dehydrogenase (LDH) > 300 U/L (OR, 18.35), and CRP > 1 mg/dL (OR, 11.31) significantly indicated aggravation in the 1st, 2nd, 3rd, and 4th 5-day periods, respectively. PCR positivity lasted fora median of 22 days and 32 days after the onset of illness in the non-aggravation and aggravation groups, respectively.Conclusion: Old age was associated with early severe presentation. Clinical aggravation among asymptomatic or mild patients could not be predicted initially but was heralded by fever and several laboratory markers during the clinical course.