Abstract
The identification of asymptomatic, non-severe presymptomatic, and severe presymptomatic coronavirus disease 2019 (COVID-19) in patients may help optimize risk-stratified clinical management and improve prognosis. This single-center case series from Wuhan Huoshenshan Hospital, China, included 2,980 patients with COVID-19 who were hospitalized between February 4, 2020 and April 10, 2020. Patients were diagnosed as asymptomatic (n = 39), presymptomatic (n = 34), and symptomatic (n = 2,907) upon admission. This study provided an overview of asymptomatic, presymptomatic, and symptomatic COVID-19 patients, including detection, demographics, clinical characteristics, and outcomes. Upon admission, there was no significant difference in clinical symptoms and CT image between asymptomatic and presymptomatic patients for diagnosis reference. The mean area under the receiver operating characteristic curve (AUC) of the differential diagnosis model to discriminate presymptomatic patients from asymptomatic patients was 0.89 (95% CI, 0.81-0.98). Importantly, the severe and non-severe presymptomatic patients can be further stratified (AUC = 0.82). In conclusion, the two-step risk-stratification model based on 10 laboratory indicators can distinguish among asymptomatic, severe presymptomatic, and non-severe presymptomatic COVID-19 patients on admission. Moreover, single-cell data analyses revealed that the CD8+T cell exhaustion correlated to the progression of COVID-19.
Highlights
Coronavirus disease 2019 (COVID-19) is a self-limiting disease in more than 80% of patients, and severe pneumonia occurs in approximately 15% of patients
To ensure the even distribution of confounders among the study groups, baseline correction was performed [17], and we obtained a sample of 1,752 symptomatic COVID-19 patients, of whom 908 (51.8%) and 844 (48.2%) had non-severe and severe illness, respectively (Figure 2A)
These analyses indicate that the liver and kidney were the most common affected organs in all COVID-19 patients, whereas indicators for heart and liver function showed the most significant differences between asymptomatic and presymptomatic patients
Summary
Coronavirus disease 2019 (COVID-19) is a self-limiting disease in more than 80% of patients, and severe pneumonia occurs in approximately 15% of patients. Asymptomatic and presymptomatic viral shedding poses a big challenge to infection control and adds complexity to appropriate clinical decision-making and resource allocation [10, 11]. It is noteworthy that the mortality rate varies from country to country, possibly reflecting the differences in how rapidly local health authorities respond to isolate and initiate effective stratification and management strategies for the infected population [12]. The prediction of asymptomatic, nonsevere presymptomatic, and severe presymptomatic COVID-19 in patients could facilitate clinical resource allocation by health authorities, and improve the prognosis of patients. At present, there is no method for the risk stratification of asymptomatic and presymptomatic COVID-19 patients
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