Abstract
Coronavirus disease 2019 (COVID-19) patients were classified into four clinical stages (uncomplicated illness, mild, severe and critical pneumonia) depending on disease severity. We aim to investigate the corresponding clinical, radiological and laboratory characteristics between different clinical stages. A retrospective, single-centre study of 101 confirmed patients with COVID-19 at Renmin Hospital of Wuhan University from 2 January to 28 January 2020 was enrolled; follow-up endpoint was on 8 February 2020. Clinical data were collected and compared during the course of illness. The median age of the 101 patients was 51.0 years and 33.6% were medical staff. Fever (68%), cough (50%) and fatigue (23%) are the most common symptoms. About 26% patients underwent the mechanical ventilation and 98% patients were treated with antibiotics. Thirty-seven per cent patients were cured and 11 died. On admission, the number of patients with uncomplicated illness, mild, severe and critical pneumonia were 2 [2%], 86 [85%], 11 [11%] and 2 [2%]. Forty-four of the 86 mild pneumonia progressed to severe illness within 4 days, with nine patients worsened due to critical pneumonia within 4 days. Two of the 11 severe patients improved to mild condition while three others deteriorated. Significant differences were observed among groups of different clinical stages in numbers of influenced pulmonary segments (6 vs. 12 vs. 17, P < 0.001). A significantly upward trend was witnessed in ground-glass opacities overlapped with striped shadows (33% vs. 42% vs. 55% vs. 80%, P < 0.001), while pure ground-glass opacities gradually decreased as disease progressed (45% vs. 35% vs. 24% vs. 13%, P < 0.001) within 12 days. Lymphocytes, prealbumin and albumin showed a downtrend as disease progressed from mild to severe or critical condition, an uptrend was found in white blood cells, C-reactive protein, neutrophils and lactate dehydrogenase. The proportions of serum amyloid A > 300 mg/l in mild, severe and critical conditions were 18%, 46% and 71%, respectively.
Highlights
As the first cases of pneumonia of unknown origin were officially reported in China on 8 December 2019, this disease has rapidly spread to many other regions within China and abroad [1]
There are many similarities, indicated by the published literatures, between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS as well as MERS, such as that they are all mainly transmitted through respiratory droplets, and their most common symptom is fever [1,2,3]
They usually die of acute respiratory distress syndrome (ARDS) and multiple organ failure caused by cytokine storm [5]
Summary
As the first cases of pneumonia of unknown origin were officially reported in China on 8 December 2019, this disease has rapidly spread to many other regions within China and abroad [1]. There are many similarities, indicated by the published literatures, between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS as well as MERS, such as that they are all mainly transmitted through respiratory droplets, and their most common symptom is fever [1,2,3]. COVID-19 usually has abnormalities on chest computed tomography (CT), of which the most typical one is ground-glass opacity, and the lesions are generally multiple and located in the posterior or peripheral lung [6]. Patients infected with SARS-CoV-2 normally develop symptoms in 2−7 days after infection with a rapid disease progress. They usually die of acute respiratory distress syndrome (ARDS) and multiple organ failure caused by cytokine storm [5]
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