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Clinical progression of patients with COVID-19 in Shanghai, China.
Journal of Infection ( IF 14.3 ) Pub Date : 2020-03-19 , DOI: 10.1016/j.jinf.2020.03.004 Jun Chen 1 , Tangkai Qi 1 , Li Liu 1 , Yun Ling 2 , Zhiping Qian 3 , Tao Li 4 , Feng Li 5 , Qingnian Xu 6 , Yuyi Zhang 3 , Shuibao Xu 1 , Zhigang Song 7 , Yigang Zeng 8 , Yinzhong Shen 1 , Yuxin Shi 9 , Tongyu Zhu 8 , Hongzhou Lu 2
Journal of Infection ( IF 14.3 ) Pub Date : 2020-03-19 , DOI: 10.1016/j.jinf.2020.03.004 Jun Chen 1 , Tangkai Qi 1 , Li Liu 1 , Yun Ling 2 , Zhiping Qian 3 , Tao Li 4 , Feng Li 5 , Qingnian Xu 6 , Yuyi Zhang 3 , Shuibao Xu 1 , Zhigang Song 7 , Yigang Zeng 8 , Yinzhong Shen 1 , Yuxin Shi 9 , Tongyu Zhu 8 , Hongzhou Lu 2
Affiliation
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.
更新日期：2020-03-19
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