Clinical progression of patients with COVID-19 in Shanghai, China. Issue 5 (May 2020)

• Record Type: Journal Article
• Authors: Chen, Jun; Qi, Tangkai; Liu, Li; Ling, Yun; Qian, Zhiping; Li, Tao; Li, Feng; Xu, Qingnian; Zhang, Yuyi; Xu, Shuibao; Song, Zhigang; Zeng, Yigang; Shen, Yinzhong; Shi, Yuxin; Zhu, Tongyu; Lu, Hongzhou
• Is Part Of: Journal of infection. Volume 80:Issue 5(2020)
• Page Start: e1
• Page End: e6
• Publication Date: 2020-05
• Subjects: COVID-19 -- SARS-CoV-2 -- Clinical progression -- Viral clearance -- Clinical characteristics; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2020.03.004
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: Most of the COVID-19 cases are mild. The estimated median duration of fever was 10 days. Radiological improvement was observed on 14 days after onset of symptoms. The median duration to negative reverse-transcriptase PCR tests of upper respiratory tract samples was 11 days. Summary: Background: Studies on the 2019 novel coronavirus disease (COVID-19) have generally been limited to the description of the epidemiology and initial clinical characteristics. We investigated the temporal progression in patients with COVID-19. Methods: In this retrospective, single-center study, we included confirmed cases of COVID-19 from Jan 20 to Feb 6, 2020 in Shanghai. Final date of follow-up was February 25, 2020. Results: Of the 249 patients enrolled, the median age was 51 years old, and 126 (50.6%) were male. The duration from onset of symptoms to hospitalization was 4(2–7) days in symptomatic patients. Fever was occurred in 235(94.3%) patients. A total of 215 (86.3%) patients had been discharged after 16(12–20) days hospitalization. The estimated median duration of fever in all the patients with fever was 10 days (95 confidential intervals [CIs]: 8–11 days) after onset of symptoms. Patients who were transferred to intensive care units (ICU) had significantly longer duration of fever as compared to those not in ICU (31 days v.s. 9 days after onset of symptoms, respectively, P <0.0001). Radiological aggravation of initial image was observed in 163 (65.7%) patients on day 7 after onset of symptoms. 154(94.5%) of these patients showed radiological improvement on day 14. The median duration to negative reverse-transcriptase PCR tests of upper respiratory tract samples was 11 days (95 CIs: 10–12 days). Viral clearance was more likely to be delayed in patients in ICU than those not in ICU ( P <0.0001). In multivariate logistical analysis, age (Odds ratio [OR] = 1.06) and CD4 T cell count (OR = 0.55 per 100 cells/ul increase) were independently associated with ICU admission. Conclusions: The majority of COVID-19 cases are mild. The clinical progression pattern suggests that early control of viral replication and application of host-directed therapy in later stage is essential to improve the prognosis of CVOID-19.