Clinical Characteristics, Treatment, and Prognosis of 74 COVID-19 Patients from Cities outside Wuhan: A Descriptive Study

Abstract

Background: Since December 2019, pneumonia caused by a novel coronavirus (SARS-CoV-2), namely COVID-19, has rapidly spread from Wuhan city to other cities across China, with the cumulative number of infections reaching 80,000. According to official data from the Chinese Center for Disease Control and Prevention, clinical characteristics of COVID-19 patients in Wuhan are significantly different from COVID-19 patients in other cities. Objective: To describe the epidemiology, clinical characteristics, treatment, and prognosis of 74 hospitalized patients with COVID-19. Design: Retrospective, single-center case study. Methods: Clinical data of 74 COVID-19 patients discharged from the Anhui Provincial Hospital Infectious Disease Hospital (Hefei city, Anhui Province) from January 21 to February 25, 2020, were collected to analyze the epidemiological, demographics, laboratory, radiological, and treatment data. Thirty-two patients were followed up and tested for the presence of the viral nucleic acid and by pulmonary computed tomography (CT) scan at 7 and 14 days after they were discharged. Results: Among all COVID-19 patients, 60% were young adults (19–65 years), with more males than females. Thirty-six patients had a history of close contact with people from Wuhan two weeks before the disease onset, accounting for 49% of the total. The median incubation period for patients was 6 days; the median period from symptom onset to admission was 6 days, and the median length of hospital stay was 13 days. Fever symptoms were presented in 84% of the patients, and the second most common symptom was cough (74%), followed by fatigue and expectoration (27%). Lymphopenia occurred in 46% of the patients and was common (61%) in the patients in the intensive care unit (ICU). Inflammatory indicators, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin (IL)-6 of the ICU patients were significantly higher than that of the non-ICU patients. However, 50% of the patients had their CD4/CD8 ratio lower than 1.1. The CT results showed no signs of pneumonia in 8% (six cases) of the patients and unilateral and bilateral involvements in 22% and 70% of the patients, respectively. Antiviral therapy was used to treat 97% of patients (oral administration of lopinavir and ritonavir tablets), 81% received antibiotic prevention or treatment, 22% interferon nebulization, and relatively few patients received steroid and gamma globulin pulse therapies. Eighty-three percent of ICU patients inhaled high-flow oxygen and did not receive invasive ventilation. One patient died of acute cerebral infarction accompanied by cerebral herniation and had ground-glass opacities in the lung and positive viral nucleic acid testing during hospitalization. Thirty-two patients received initial follow-up, and two of them had positive viral nucleic acids in the retests but no reinfection signs. Conclusion: Approximately half of the COVID-19 patients in our hospital had a history of close contact with people from Wuhan. Fever, cough, expectoration, and fatigue were the most common symptoms. Compared with patients in Wuhan, COVID-19 patients in Anhui Province had milder conditions and optimistic therapeutic outcomes, suggesting that there may be some regional differences in the transmission of SARS-CoV-2 between different cities.