JAMA: novel coronavirus pneumonia in 138 hospitalized patients in Central South Hospital of Wuhan University

Author: the whole genome sequencing and phylogenetic tree analysis of tower simper showed that 2019 ncov is a different branch of β - coronavirus related to human severe acute respiratory syndrome (SARS CoV) and Middle East respiratory syndrome (mers COV) 2019-ncov has typical characteristics of coronaviridae and is classified into β - coronavirus 2B pedigree 2019-ncov is very similar to bat coronavirus, so it is speculated that bat is the main source of the virus Although the origin of 2019 ncov is still under investigation, the current evidence suggests that it was transmitted to humans through wildlife illegally sold at the South China seafood wholesale market in Wuhan Huang et al First reported 41 cases of NCIP, most of which had a history of contact with the South China seafood wholesale market The clinical manifestations of these patients include fever, dry cough, dyspnea, myalgia, fatigue, normal or decreased leukocyte count, and imaging evidence of pneumonia Severe cases can lead to organ dysfunction (such as shock, acute respiratory distress syndrome [ARDS], acute heart injury and acute kidney injury) and death Chen et al Reported the findings of 99 cases of NCIP from the same hospital The results showed that 2019-ncov infection was concentrated in close contact population, which was more likely to affect elderly men with coexisting diseases (i.e comorbidities), and may lead to ARDS However, no differences in clinical characteristics between severe and non severe cases have been reported Case reports have confirmed the interpersonal transmission of NCIP At present, there are no effective drugs and vaccines for NCIP In a new study, researchers from Central South Hospital, Wuhan University, China, described the clinical characteristics of 138 patients hospitalized with NCIP and compared severe cases admitted to intensive care unit (ICU) with non serious cases not admitted to ICU The relevant research results were published online in the Journal of JAMA on February 7, 2020, under the title of "clinical characteristics of 138 hospitalized patients with 2019 new coronavirus – infected pineoniain Wuhan, China" (1) The median age of 138 patients with NCIP was 56 years (IQR, 42-68; range: 22-92 years), 75 of them (54.3%) were male Of these patients, 102 (73.9%) entered the isolation ward and 36 (26.1%) were admitted to ICU due to organ dysfunction (Table 1) The median duration from initial symptoms to dyspnea, admission and ARDS was 5 days (IQR, 1-10), 7 days (IQR, 4-8) and 8 days (IQR, 6-12), respectively (Table 1) Of the 138 patients, 64 (46.4%) had one or more coexisting diseases Hypertension (43 [31.2%]), diabetes (14 [10.1%]), cardiovascular disease (20 [14.5%]) and malignant tumor (10 [7.2%]) are the most common coexisting diseases Table 1.2019-baseline characteristics of patients with ncov infection The most common symptoms were fever (136 [98.6%]), fatigue (96 [69.6%]), dry cough (82 [59.4%]), myalgia (48 [34.8%]) and dyspnea (43) [31.2%] The less common symptoms are headache, dizziness, abdominal pain, diarrhea, nausea and vomiting (Table 1) A total of 14 patients (10.1%) initially developed diarrhea and nausea, and fever and dyspnea occurred 1 to 2 days later Patients requiring ICU care (n = 36) were significantly older (median age 66 [IQR, 57-78] vs 51 [IQR, 37-62]; P < 001) and more likely to have underlying comorbidities, including hypertension (21 [58.3%] vs 22 [21.6%], diabetes (8 [22.2%] vs 6 [5.9%]), cardiovascular disease (9 [25.0%] vs 11 [10.8%]) ）And cerebrovascular diseases (6 [16.7%] vs 1 [1.0%]) Compared with patients who did not enter the ICU (hereinafter referred to as non ICU patients), patients who entered the ICU (hereinafter referred to as ICU patients) are more likely to have pharyngeal pain, dyspnea, dizziness, abdominal pain and anorexia (2) The vital signs and laboratory parameters of ICU patients and non ICU patients had no difference in heart rate, respiratory frequency and mean arterial pressure between ICU patients and non ICU patients These indicators were recorded on the day of admission of all patients, and then differentiated according to whether the patients entered the ICU or not There are many differences in laboratory test results between ICU patients and non ICU patients (Table 2), including high white blood cell and neutrophil counts, and high levels of D-dimer, creatine kinase and creatine CT scan of the 138 patients showed bilateral involvement (Figure 1) The median time from symptom onset to admission to ICU was 10 days (IQR, 6-12) (Table 3) On the day of ICU entry, the median Glasgow Coma index, acute physiology and chronic health score II, and sequential organ failure estimated scores were 15 (IQR, 9-15), 17 (IQR, 10-22) and 5 (IQR, 3-6), respectively (Table 3) The median blood oxygen partial pressure was 68mmhg (IQR, 56-89), and the median ratio of blood oxygen partial pressure to inhaled oxygen was 136mmhg (IQR, 103-234) Figure 1 novel coronavirus (2019-ncov) infection in a 52 year old patient with chest CT image in 2019 Table 2.2019-results of laboratory tests on admission of patients with ncov infection Table 3 Severity score and blood gas analysis of 2019-ncov infected patients entering ICU (3) See Table 4 for organ dysfunction and treatment methods of 138 patients with organ dysfunction and main intervention measures As of February 3, 2020, 85 patients (61.6%) were still hospitalized A total of 47 patients (34.1%) were discharged and 6 patients (4.3%) died Of the 36 patients who entered the ICU, 11 remained in the ICU, 9 were discharged, 10 were transferred to the general ward, and 6 died Of the 11 patients who stayed in ICU, 6 received invasive ventilation (one of them switched to extracorporeal membrane oxygenation) and 5 received noninvasive ventilation The common complications included shock (12 [8.7%]), ARDS (27 [19.6%]), arrhythmia (23 [16.7%]), and acute heart injury (10 [7.2%]) Compared with non ICU patients, ICU patients are more likely to have one of these complications Table 4.2019-complications and treatment of patients with ncov infection Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), many patients received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]; glucocorticoid (62) [44.9%]) In ICU, 4 patients (11.1%) received high flow oxygen, while 15 patients (44.4%) received noninvasive ventilation Seventeen patients (47.2%) needed invasive mechanical ventilation, four of them received extracorporeal membrane oxygenation as rescue treatment A total of 13 patients received vasopressin and 2 patients received renal replacement therapy (4) In order to determine the main clinical features during the development of NCIP, the dynamic changes of six clinical laboratory parameters (including hematology parameters and biochemical parameters) were tracked at 2-day intervals from the first day to the 19th day after the onset of the disease By the end of January 28, 2020, data from 33 patients with complete clinical processes were analyzed (Figure 2) During hospitalization, most patients had significant lymphocytopenia, and over time, non survivors had more severe lymphocytopenia The number of leukocytes and neutrophils in non survivors was higher than that in survivors D-dimer level of non survivors was higher than that of survivors Similarly, with the development of the disease and the deterioration of the clinical situation, the levels of blood urea and creatinine increased gradually before death Fig 2.33 novel coronavirus pneumonia patients' laboratory parameters (5) It is speculated that hospital-related transmission and infection occurred in 57 (41.3%) of 138 patients, including 17 (12.3%) patients who had been hospitalized for other reasons and 40 medical staff (29%) Of these inpatients, 7 were from surgery, 5 from internal medicine and 5 from oncology Among the infected medical staff, 31 (77.5%) worked in general ward, 7 (17.5%) in emergency department and 2 (5%) in ICU One patient in the current study was sent to surgery for abdominal symptoms It is presumed that more than 10 medical staff in the surgery were infected by the patient It is speculated that there is also transmission between patients: at least four inpatients in the same ward are infected, and all patients show atypical abdominal symptoms One of the four patients had fever and was diagnosed with 2019 ncov infection during hospitalization Then, the patient was quarantined Soon, three other patients in the same ward had fever, abdominal symptoms, and were diagnosed with 2019 ncov infection This study has several limitations First, NCIP was diagnosed by RT-PCR using respiratory tract samples No serum was obtained to evaluate viremia Viral load is a potential useful marker related to the severity of coronavirus infection and should be determined in NCIP Secondly, hospital-related transmission / infection has not yet been confirmed, only based on the time and manner of contact with infected patients and the subsequent development of infection to guess and infer Third, most of the 138 patients were still hospitalized at the time of submission of this paper Therefore, it is difficult to assess the risk factors for poor prognosis, and it is necessary to continue to observe the natural history of the disease Overall, of the 138 patients hospitalized with NCIP, 41% are presumed to be infected through hospital-related 2019-ncov transmission (this needs to be further confirmed), 26% enter ICU, with a mortality rate of 4.3% Reference: 1 Dawei Wang et al Dynamic profile of laboratory parameters in 33 patients with new coronavirus – infected pneumonia (NCIP) JAMA, 2020, DOI: 10.1001/jama.2020.1585 2 New coronavirus infected 40 staff in single Wuhan hospital: study https://mediaexpress.com/news/2020-02-coronavirus-infected-staff-wuhan-hospital.html