Presenting Characteristics, Comorbidities, and Outcomes Among Hospitalized Patients with 2019 Novel Coronavirus-infected Pneumonia in Tehran, Iran

Abstract

Background: On February 19 2020, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) reported in Qom, Iran. The number of cases has increased rapidly but information on the differences in clinical characteristics of affected patients in different countries is limited. It seems that people with underlying diseases not only have a higher risk of developing the NCIP disease but also are more likely to die from the virus infection. Objectives: This study aimed to describe which one of NCIP patients are at higher risk for severe illness and what is the epidemiological, clinical, laboratory, radiological characteristics, and outcomes of the disease. Methods: Prospective, case series of the 50 hospitalized NCIP patients in two hospitals in Tehran, Iran, from March 1 to March 15, 2020, was implemented. The final date of follow-up was March 18, 2020. The final date of follow-up was March 18, 2020. Epidemiological, demographic, clinical, laboratory, radiological, treatment, and outcome data were collected from electronic or printed medical records with data collection forms and analyzed. Results: More than half of the patients were men (27 [54%]); the majority of them had underlying diseases, including hypertension (33 [66%]), diabetes mellitus (29 [58%]), chronic heart failure (19 [38%]), chronic renal failure (19 [38%]), and autoimmune diseases (18 [36%]). The median age was 60 years (IQR 41.5 - 68.5). Common symptoms of illness were fever (50 [100%]), sore throat (50 [100%]), dyspnea (44 [88%]), myalgia (43 [86%]), cough (42 [84%]), fatigue (39 [78%]), and diarrhea (28 [56%]). The majority of patients had lymphopenia 49 (98%), 24 (48%) leukocytosis, and 32 (64%) of them had thrombocytopenia. All patients had pneumonia with patchy shadows or ground-glass opacity on chest computed tomographic scans. Twelve (24%) patients had a decreased level of consciousness. Thirty-three patients (66%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (ARDS) (18 [36%]), arrhythmia (19 [38%]), and shock (14 [28%]). As of March 18, 37 patients (74%) were discharged, and 13 died (26%). Conclusions: Hospitalized NCIP patients who have serious underlying chronic illness might be at higher risk for severe illness. Common symptoms of illness were fever, sore throat, dyspnea, myalgia, cough, and fatigue. Major complications during hospitalization included ARDS, arrhythmia, and shock. Bilateral distribution of patchy shadows and ground-glass opacity was a typical hallmark of CT scans for NCIP. Currently, there is no effective drug treatment. Gaps in our knowledge need fulfillment by future studies with a higher sample size.