Coronavirus Disease 2019 Patients In Wuhan Research Articles

Takotsubo Syndrome as a Complication of Mild COVID-19: A Case Report

Introduction As the number of cases of coronavirus disease 2019 (COVID-19) has reached tens of millions worldwide, the understanding of its clinical manifestations has grown. These have been described as a range of systemic repercussions resulting from an interplay between direct organ damage and exaggerated host immune response. , In a descriptive case series study of COVID-19 patients in Wuhan, 44% of patients had either elevated cardiac biomarkers or new changes in electrocardiogram (ECG) and imaging exams, and 34% of [...]

Nurses' Grief Counseling for Bereaved Family Members of COVID-19 Patients in Wuhan, China: A Cross-Sectional Survey

This is the first study to assess nurses' attitudes and skills regarding grief counseling for bereaved family members of patients who died from coronavirus disease 2019 (COVID-19) in Wuhan, China. Using a cross-sectional design, 412 nurses selected through convenience sampling completed a demographic characteristics survey, Attitudes of Grief Counseling Scale, (AGCS) and Skills of Grief Counseling Scale (SGCS). Average AGCS score was 32.89 (SD = 9.46), with an overall percentage rate score of 65.6%. Factors influencing attitudes toward grief counseling included other grief counseling skills, educational level, communication skills, and training related to grief counseling (p < 0.05). Average SGCS score was 18.81 (SD = 4.25), with an overall percentage rate score of 58.7%. Factors influencing skills of grief counseling included responsibilities and roles, frequency of contact with the bereaved, and positive view of grief counseling (p < 0.05). Nurses' attitudes and skills regarding grief counseling were low, indicating an urgent need to improve grief counseling. [Journal of Psychosocial Nursing and Mental Health Services, 59(11), 18-24.].

Sudden death of COVID-19 patients in Wuhan, China: A retrospective cohort study

BackgroundIn December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan city and rapidly spread throughout China. So far, it has caused ~ 4000 deaths in this country. We aimed to systematically characterize clinical features and determine risk factors of sudden death for COVID-19 patients.MethodsDeceased patients with COVID-19 in Tongji hospital from January 22 to March 23, 2020 were extracted. Patients who died within 24 hours after admission were identified as sudden deaths, and the others formed non-sudden deaths. The differences in clinical characteristics between the two groups were estimated. Risk factors associated with sudden deaths were explored by logistic regression.Results281 deceased patients were enrolled in this study. Sudden death occurred in 28 (10.0%) patients, including 4 (14.3%) admitted to the intensive care unit. Fatigue was more common in sudden deaths (11, 47.8%) than in non-sudden deaths (40, 17.2%). Both the count and percentage of eosinophils were lower in sudden deaths than that in non-sudden deaths (P = 0.006 and P = 0.004). Compared with non-sudden deaths, sudden deaths had higher plasma levels of procalcitonin, C-reactive protein, D-dimer, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, lactate dehydrogenase, alkaline phosphatase and N-terminal pro-brain natriuretic peptide. There were not significant differences in gender, age, chest CT image features and comorbidities observed.ConclusionsThe differences between the two groups suggested more severe systemic inflammation, multi-organ dysfunction, especially impaired liver and heart function in COVID-19 patients who died suddenly after admission. More researches are needed to verify these points.

Understanding COVID-19 in Wuhan From the Perspective of Cold-Dampness: Clinical Evidences and Mechanisms.

Traditional Chinese medicine (TCM) has played a significant role in the treatment of coronavirus disease 2019 (COVID-19) in Wuhan City. During the epidemic, Academician Tong Xiaolin suggested a close association of COVID-19 with cold-dampness, an etiological factor in TCM, by summarizing the characteristics of the COVID-19 patients in Wuhan. and the theory of Cold-dampness Plague was proposed. Based on the Cold-dampness Plague theory, a series of TCM drugs, such as Huoxiang Zhengqi Dropping Pills, Lianhua Qingwen Granules Hanshiyi Formula, and Tongzhi Granule were developed for the different stages, namely mild, moderate, severe, recovery, of the COVID-19. In addition, clinical evidences were obtained through randomized clinical trials or retrospective cohort studies. The Anti-SARS-CoV-2 mechanism of the TCM prescriptions were then summarized from the four aspects: targeting the ACE2 and 3CLPro, targeting cytokines, targeting acute immune responses to SARS-CoV-2, and targeting pulmonary fibrosis. Despite the clinical efficacy and therapeutic pharmacology speculation, more studies such as large-scale randomized clinical trials, cell and animal experiments are needed to further verify the theory of the Cold-dampness Plague in COVID-19 patients.

Declined eGFR Associated With Poor Prognosis in COVID-19 Patients in Wuhan, China: A Retrospective Cohort Study

Background: Increasing evidence revealed that kidney was one of the targets of SARS-CoV-2. However, the incidences of kidney abnormalities were significantly different, from 0·5 to 75·4% in coronavirus disease 2019 (COVID-19) patients. The association of kidney injury with prognosis remain controversial.Methods: In this retrospective cohort study, laboratory confirmed COVID-19 in patients with severe type were enrolled. Demographic, clinical, and laboratory data were collected. Association of estimated glomerular filtration rate (eGFR) with 28-days mortality was analyzed.Findings: The total 28-days mortality of hospitalization was 22·3% (79/354). Non-survivors had a significantly declined eGFR levels than survivors (75·95 [IQR: 47·22,92·84] ml/min/1·73m2 vs. 96·43 [IQR: 84·11,108·47] ml/min/1·73m2, P 2) was significantly higher than that in normal eGFR group (38·5% vs. 10·7%, P Interpretation: Declined eGFR was associated with poor prognosis, and could be used an independent risk factor of 28-days mortality in COVID-19 patients. Early detection, and surveillance for eGFR may benefit to identify patients with high-risk of progression.Funding Information: Program of Key Talents of Medical Science in Jiangsu Province, Suzhou science and technology development plan.Declaration of Interests: The authors have declared that no conflict of interest exists.Ethics Approval Statement: This study was approved by the institutional review boards at the First Affiliated Hospital of Soochow University and Wuhan Tongji Hospital. As COVID-19 is an emerging infectious disease, the written informed consent was exempted.

Influence of Cigarettes and Alcohol on the Severity and Death of COVID-19: A Multicenter Retrospective Study in Wuhan, China.

BackgroundThe recent emergence and rapid global spread of coronavirus disease 2019 (COVID-19) is leading to public health crises worldwide. Alcohol consumption and cigarette smoking (CS) are two known risk factors in many diseases including respiratory infections.MethodsWe performed a multi-center study in the four largest hospitals designated for COVID-19 patients in Wuhan. There are totally 1547 patients diagnosed with COVID-19 enrolled in the study, alcohol consumption and CS history were evaluated among these patients. The epidemiology, laboratory findings and outcomes of patients contracted COVID-19 were further studied.ResultsOur findings indicated that COVID-19 patients with a history of CS tend to have more severe outcomes than non-smoking patients. However, alcohol consumption did not reveal significant effects on neither development of severe illness nor death rates in COVID-19 patients.ConclusionCS is a risk factor for developing severe illness and increasing mortality during the SARS-CoV-2 infection. We believe that our findings will provide a better understanding on the effects of alcohol intake and CS exposure in COVID-19 patients.

Risk factors associated with 28-day all-cause mortality in older severe COVID-19 patients in Wuhan, China: a retrospective observational study

We aimed to analyse clinical characteristics and identify risk factors predicting all-cause mortality in older patients with severe coronavirus disease 2019 (COVID-19). A total of 281 older patients with severe COVID-19 were categorized into two age groups (60–79 years and ≥ 80 years). Epidemiological, clinical, and laboratory data, and outcome were obtained. Patients aged ≥ 80 years had higher mortality (63.6%) than those aged 60–79 years (33.5%). Anorexia and comorbidities including hypertension, diabetes and COPD, higher levels of lactate dehydrogenase (LDH), osmotic pressure, C-reactive protein, D-dimer, high-sensitivity troponin I and procalcitonin, and higher SOFA scores were more common in patients aged > 80 years than those aged 60–79 years and also more common and higher in non-survivors than survivors. LDH, osmotic pressure, C-reactive protein, D-dimer, high-sensitivity troponin I, and procalcitonin were positively correlated with age and sequential organ failure assessment (SOFA), whereas CD8+ and lymphocyte counts were negatively correlated with age and SOFA. Anorexia, comorbidities including hypertension, diabetes, and chronic obstructive pulmonary disease (COPD), LDH, osmotic pressure, and SOFA were significantly associated with 28-day all-cause mortality. LDH, osmotic pressure and SOFA were valuable for predicting 28-day all-cause mortality, whereas the area under the receiver operating characteristic curve of LDH was the largest, with sensitivity of 86.0% and specificity of 80.8%. Therefore, patients with severe COVID-19 aged ≥ 80 years had worse condition and higher mortality than did those aged 60–79 years, and anorexia and comorbidities including hypertension, diabetes, COPD, elevated plasma osmotic pressure, LDH, and high SOFA were independent risk factors associated with 28-day all-cause mortality in older patients with severe COVID-19. LDH may have the highest predictive value for 28-day all-cause mortality in all examined factors.

Psychological distress and sleep quality of COVID-19 patients in Wuhan, a lockdown city as the epicenter of COVID-19

The major Corona Virus Disease 2019 (COVID-19) outbreak caused tens of thousands of diagnosed patients quarantined and treated in designated hospitals in Wuhan, the epicenter of the disease in China. Evidence for the psychological problems of COVID-19 patients was limited. Here we report a cross-sectional study of the mental distress and sleep quality of patients in a single center in Wuhan. The study was based on a combined questionnaire of basic questions designed by the study group, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). On Feb 17th and Mar 14th, two groups of patients were recruited respectively in a designated hospital for COVID-19. Univariate analysis and regression models were used to identify predictors for patients' psychological distress and sleep quality. In total, there were 202 participants in our combined sample. The average SAS, SDS, and PSQI score of participants were 44.2, 51.7, and 9.3 respectively. Factors associated with SAS score include gender, subjective evaluation of disease symptoms, and evaluation of medical staffs' attitude. Gender, age, education level, frequency of contacting with family, subjective knowledge level of COVID 19, and evaluation of medical staffs’ attitude are associated with participants SDS score. Factors associated with PSQI score are age and subjective evaluation of disease symptoms.

Clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan.

BACKGROUNDCoronavirus disease 2019 (COVID-19) has become a worldwide pandemic. We investigated the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan by retrospectively analyzing the epidemiological, clinical, and laboratory data for 218 COVID-19 patients and identifying the risk factors for liver injury by multivariate analysis.AIMTo investigate the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan.METHODSThe 218 patients included 94 males (43.1%), aged 22 to 94 (50.1 ± 18.4) years. Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were present in 42 (53.2%) and 36 (45.6%) cases, respectively, and 79 (36.2%) patients had abnormally elevated transaminase levels at admission. Patients with liver injury were older than those with normal liver function by a median of 12 years, with a significantly higher frequency of males (68.4% vs 28.8%, P < 0.001) and more coexisting illnesses (48.1% vs 27.3%, P = 0.002). Significantly more patients had fever and shortness of breath (87.3% vs 69.8% and 29.1% vs 14.4%, respectively) in the liver injury group. Only 12 (15.2%) patients had elevated total bilirubin. ALT and AST levels were mildly elevated [1-3 × upper limit of normal (ULN)] in 86.1% and 92.9% of cases, respectively. Only two (2.5%) patients had an ALT or AST level > 5 × ULN. Elevated γ-glutamyl transpeptidase was present in 45 (57.0%) patients, and 86.7% of these had a γ-glutamyl-transpeptidase level < 135 U/L (3 × ULN). Serum alkaline phosphatase levels were almost normal in all patients. Patients with severe liver injury had a significantly higher frequency of abnormal transaminases than non-severe patients, but only one case had very high levels of aminotransferases.RESULTSMultivariate analysis revealed that male sex, high D-dimer level, and high neutrophil percentage were linked to a higher risk of liver injury. The early stage of COVID-19 may be associated with mildly elevated aminotransferase levels in patients in Wuhan. Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.CONCLUSIONMale sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.

The relationship between resilience, anxiety and depression among patients with mild symptoms of COVID-19 in China: A cross-sectional study.

Aims and objectivesTo explore the role of resilience in anxiety and depression and to clarify their relationships among patients with mild symptoms of coronavirus disease 2019 (COVID‐19) in Wuhan, China.BackgroundThe outbreak of COVID‐19 has negatively affected some individuals, but resilience plays a decisive role in the response of individuals under pressure and can help them deal with pressure more effectively.DesignThe cross‐sectional descriptive correlational survey was reported in line with the STROBE guidelines.Subject and settingIn total, 296 patients from FangCang Hospital in Wuhan, Hubei, China, with mild symptoms of COVID‐19 were recruited.MethodsParticipants were recruited through convenience sampling. The data collected included their demographic information, the Connor‐Davidson Resilience Scale and Hospital Anxiety and Depression Scale.ResultsA small number of patients in this study had above threshold anxiety (subthreshold anxiety and major anxiety) and depression (subthreshold depression and major depression). The mean total resilience score of the participants was slightly below the normal level of ordinary Chinese adults. Resilience was inversely associated with and was a protective factor for both anxiety and depression in our samples. Risk factors for anxiety include being female and having colleagues with COVID‐19, while a risk factor for depression was having family members with COVID‐19.ConclusionsThis study shows that after taking the general demographics into consideration, higher levels of resilience were associated with lower anxiety and depression among mild COVID‐19 patients in Wuhan, China.Relevance to clinical practiceHealth professionals, especially clinical nurses, need to be aware of the psychological status of COVID‐19 patients and promote resilience to improve their mental health.

Serologic Response to SARS-CoV-2 in COVID-19 Patients with Different Severity.

The immense patient number caused by coronavirus disease 2019 (COVID-19) global pandemic brings the urge for more knowledge about its immunological features, including the profile of basic immune parameters. In this study, eighty-eight reported COVID-19 patients in Wuhan were recruited from January to February, 2020, including 32 severe/critical cases and 56 mild/moderate cases. Their mean age was 56.43 years (range 17–83) and gender ratio (male/female) was 43:45. We tested SARS-CoV-2 RNA with commercial kits, investigated the level of serologic IgM and IgG antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using magnetic particle chemiluminescence immunoassays, and compared the results of serologic tests and nucleic acid test (NAT). Among 88 patients, 95.45% were confirmed as positive by the combination of NAT and antibody test, which was significantly higher (P < 0.001) than by single nucleic acid test (73.86%) or serologic test (65.91%). Then the correlation between temporal profile and the level of antibody response was analyzed. It showed that seroconversion started on day 5 after disease onset and IgG level was rose earlier than IgM. Comparison between patients with different disease severity suggested early seroconversion and high antibody titer were linked with less severe clinical symptoms. These results supported the combination of serologic testing and NAT in routine COVID-19 diagnosis and provided evidence on the temporal profile of antibody response in patients with different disease severity.

Time-dependent changes in the clinical characteristics and prognosis of hospitalized COVID-19 patients in Wuhan, China: A retrospective study

Cases of coronavirus disease 2019 (COVID-19) have been breaking out around the world recently. However, the dynamic changes in the clinical symptoms and prognosis of COVID-19 patients remain unknown. According to the onset time of initial clinical symptoms, 843 COVID-19 patients admitted between Jan 22 and Feb 14, 2020 were divided into three groups: group A (Jan 21 to Jan 25, n = 324), group B (Jan 26 to Jan 31, n = 358) and group C (Feb 1 to Feb 10, n = 161). Data on the demographics, symptoms, first laboratory results, treatments and outcomes (within 12 days of hospitalization) were collected. The results showed that the median duration from symptom onset to admission shortened over time (13, 10 and 5 days, respectively, p < 0.05). Fewer patients had fever symptoms and bilateral pneumonia in group C than in the group A and B. Laboratory results showed that white blood cell, neutrophil, and platelet counts, lactic acid and D-dimer levels were lower, while lymphocyte, CD3, and CD8 counts were higher in group C. In addition, group C had more mild-moderate cases and fewer severe cases than the other two groups. More importantly, the incidence of complications (18.5%, 14.2% and 11.2%, respectively, p < 0.05) and all-cause mortality (11.7%, 8.4%, and 5.6%, respectively, p < 0.05) decreased over time. The clinical characteristics and prognosis of COVID-19 patients changed over time. Improved prognosis was found at a later stage.

Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study

BackgroundDuring the Coronavirus Disease 2019 (COVID-19) pandemic, frontline nurses face enormous mental health challenges. Epidemiological data on the mental health statuses of frontline nurses are still limited. The aim of this study was to examine mental health (burnout, anxiety, depression, and fear) and their associated factors among frontline nurses who were caring for COVID-19 patients in Wuhan, China.MethodsA large-scale cross-sectional, descriptive, correlational study design was used. A total of 2,014 eligible frontline nurses from two hospitals in Wuhan, China, participated in the study. Besides sociodemographic and background data, a set of valid and reliable instruments were used to measure outcomes of burnout, anxiety, depression, fear, skin lesion, self-efficacy, resilience, and social support via the online survey in February 2020.FindingsOn average, the participants had a moderate level of burnout and a high level of fear. About half of the nurses reported moderate and high work burnout, as shown in emotional exhaustion (n = 1,218, 60.5%), depersonalization (n = 853, 42.3%), and personal accomplishment (n = 1,219, 60.6%). The findings showed that 288 (14.3%), 217 (10.7%), and 1,837 (91.2%) nurses reported moderate and high levels of anxiety, depression, and fear, respectively. The majority of the nurses (n = 1,910, 94.8%) had one or more skin lesions, and 1,950 (96.8%) nurses expressed their frontline work willingness. Mental health outcomes were statistically positively correlated with skin lesion and negatively correlated with self-efficacy, resilience, social support, and frontline work willingness.InterpretationThe frontline nurses experienced a variety of mental health challenges, especially burnout and fear, which warrant attention and support from policymakers. Future interventions at the national and organisational levels are needed to improve mental health during this pandemic by preventing and managing skin lesions, building self-efficacy and resilience, providing sufficient social support, and ensuring frontline work willingness.

Sustainability of SARS-CoV-2 in aerosols: should we worry about airborne transmission?

Sustainability of SARS-CoV-2 in aerosols: should we worry about airborne transmission?

Clinical findings of patients with coronavirus disease 2019 in Jiangsu province, China: Aretrospective, multi-center study.

Limited data are available for clinical characteristics of patients with coronavirus disease 2019 (COVID-19) outside Wuhan. This study aimed to describe the clinical characteristics of COVID-19 and identify the risk factors for severe illness of COVID-19 in Jiangsu province, China. Clinical data of hospitalized COVID-19 patients were retrospectively collected in 8 hospitals from 8 cities of Jiangsu province, China. Clinical findings of COVID-19 patients were described and risk factors for severe illness of COVID-19 were analyzed. By Feb 10, 2020, 202 hospitalized patients with COVID-19 were enrolled. The median age of patients was 44.0 years (interquartile range, 33.0–54.0). 55 (27.2%) patients had comorbidities. At the onset of illness, the common symptoms were fever (156 [77.2%]) and cough (120 [59.4%]). 66 (32.7%) patients had lymphopenia. 193 (95.5%) patients had abnormal radiological findings. 11 (5.4%) patients were admitted to the intensive care unit and none of the patients died. 23 (11.4%) patients had severe illness. Severe illness of COVID-19 was independently associated with body mass index (BMI) ≥ 28 kg/m2 (odds ratio [OR], 9.219; 95% confidence interval [CI], 2.731 to 31.126; P<0.001) and a known history of type 2 diabetes (OR, 4.326; 95% CI, 1.059 to 17.668; P = 0.041). In this case series in Jiangsu Province, COVID-19 patients had less severe symptoms and had better outcomes than the initial COVID-19 patients in Wuhan. The BMI ≥ 28 kg/m2 and a known history of type 2 diabetes were independent risk factors of severe illness in patients with COVID-19.

Current Knowledge and Research Priorities in the Digestive Manifestations of COVID-19

Current Knowledge and Research Priorities in the Digestive Manifestations of COVID-19

Dynamic profile of RT-PCR findings from 301 COVID-19 patients in Wuhan, China: A descriptive study

BackgroundWith the spread of Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, its effect on society is amplified. We aimed to describe the viral detection results across different timepoints throughout the disease course. MethodsA retrospective study of 301 confirmed COVID-19 patients hospitalized at Tongji Hospital in Wuhan, China, were included. Demographic characteristics of the patients were collected. Upper respiratory specimens (throat and/or nasal swabs) were obtained and analyzed by real-time RT-PCR for SARS-CoV-2 infection. Period of viral infection and the contagious stage were analyzed. ResultsOf 301 hospitalized COVID-19 patients, the median age was 58 years and 51.2 % were male. The median period between symptoms presence and positive SARS-CoV-2 RT-PCR results was 16 days (IQR, 10–23, N = 301). The median period between symptoms presence and an effective negative SARS-CoV-2 RT-PCR result was 20 days (IQR, 17–24; N = 216). Infected patient ≥65 years old stayed contagious longer (22 days vs 19 days, p = 0.015). Although two consecutive negative results were confirmed in 70 patients, 30 % of them had positive viral test results for the third time. Using specimens from nasal swabs to run the RT-PCR test showed a higher positive rate than using specimens from throat swabs. ConclusionsThis large-scale investigation with 1113 RT-PCR test results from 301 COVID-19 patients showed that the average contagious period of SARS-CoV-2 infected patients was 20 days. Longer observation period and more than 2 series of negative viral test are necessary for patients ≥65 years.

Manifestations of digestive system of hospitalized patients with coronavirus disease 2019 in Wuhan, China: a single-center descriptive study

Objective To study the manifestations of digestive system of hospitalized patients with coronavirus disease 2019 (COVID-19) in Wuhan, China, and to provide a reference for disease control and treatment. Methods The data of hospitalized patients with COVID-19 in the Sino-French Branch of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 27 to February 14, 2020 were retrospectively analyzed, which included general information, positive rate of nucleic acid test, severity of disease, incubation period, initial symptoms and manifestations of digestive system. The general information, positive rate of nucleic acid detection, and manifestations of digestive system were compared between critical patients who required non-invasive or invasive assisted ventilation (critical group) and non-critical patients without assisted ventilation (non-critical group). Continuous corrected Chi-square test and independent sample median Chi-square test were used for statistical analysis. Results Among the 305 patients, there were 146 males (47.9%) and 159 females (52.1%), and the median age was 57 years old. Nucleic acid assay of nasopharyngeal swabs or pharyngeal swabs were positive in 84.1% (228/271) patients including 46 patients (15.1%) of critical group and 259 patients (84.9%) of non-critical group. The incubation period was one to fifteen days, and the median period was six days. The initial symptoms were mainly fever (81.1%, 163/201), cough (39.3%, 79/201), fatigue (54.7%, 110/201), and loss of appetite (50.2%, 101/201). In one to ten days after the disease onset, 79.1% (159/201) of patients developed gastrointestinal symptoms including nausea (29.4%, 59/201), vomiting (15.9%, 32/201), or abdominal pain (6.0%, 12/201). 49.5% (146/295) of patients had diarrhea, with a median time of 3.3 days, (3.3±1.6) times per day, and a duration of (4.1±2.5) days. After excluding possible drug-related diarrhea, the incidence of diarrhea was still 22.2%. Only 6.9% (4/58) of patients had positive fecal leukocytes or fecal occult blood test. Alanine aminotrans ferase (ALT), aspartate aminotransferase (AST), or total bilirubin (TBil) increased in 39.1% (119/304) of patients on admission. Patients with ALT or AST ≥ 80 U/L only accounted for 7.9% (24/304) and 6.3% (19/304), respectively. About 2.0% (6/304) of patients also had increased TBil level, and the average level was (37.4±21.1) μmol/L. The median age of critical group was older than that of non-critical group (65 years vs. 56 years), the proportion of patients with abnormal liver function and slightly increased AST (40- 0.05). Conclusions The manifestation of digestive system of hospitalized COVID-19 patients in Wuhan is significant, the proportion of patients with diarrhea and abnormal aminotransferase level is high. And on admission the proportion of patients with abnormal liver function of critical group is higher than that of non-critical group, which will provide reference for the prevention and treatment of COVID-19. Key words: 2019-nCoV; COVID-19; Diarrhea; Liver function; Gastrointestinal tract

Chinese experts' consensus on diagnosis and treatment of severe and critical coronavirus disease 2019 (revised edition)

The outbreak of coronavirus disease 2019 (COVID-19) is serious and there is no effective treatment to date. In order to reduce the mortality of severe and critical COVID-19, experts from the first-line in related fields in China were organized to analyze, discuss and summarize the diagnosis and treatment of severe and critical COVID-19 patients in Wuhan and other severe epidemic areas, and formulate the expert consensus. The first edition was released on February 22, 2020, and the revised one on March 4, 2020.

Clinical Findings of Patients with Coronavirus Disease 2019 in Jiangsu Province, China: A Retrospective, Multi-Center Study

Background: Limited data are available for clinical characteristics of patients with coronavirus disease 2019 (COVID-19) outside of Wuhan. This study aimed to describe the clinical characteristics of COVID-19 and identify the risk factors for severe illness of COVID-19 in Jiangsu province, China. Methods: Clinical data of hospitalized COVID-19 patients were retrospectively collected in ten hospitals from nine cities of Jiangsu province, China. Clinical findings of COVID-19 patients were described and risk factors for severe illness of COVID-19 were analyzed. Findings: By Feb 10, 2020, 221 hospitalized patients with COVID-19 were enrolled. The median age of patients was 45.0 years (interquartile range, 33.5–56.0). 60 (27.1%) patients had comorbidities. At onset of illness, the common symptoms were fever (171 [77.4%]) and cough (133 [60.2%]). 68 (30.8%) patients had lymphopenia. 211 (95.5%) patients had abnormal radiological findings. 11 (5.0%) patients were admitted to the intensive care unit and none of the patients died. 25 (11.3%) patients had severe illness. Severe illness of COVID-19 was independently associated with body mass index (BMI)≥28 kg/m 2 (odds ratio [OR], 5.872; 95% confidence interval [CI], 1.595 to 21.621; P=0.008) and a known history of type 2 diabetes (OR, 7.033; 95% CI, 1.908 to 25.921; P=0.003). Interpretation: In this case series in Jiangsu Province, COVID-19 patients have less severe symptoms and have better outcomes than the initial COVID-19 patients in Wuhan. The BMI ≥ 28 kg/m 2 and a known history of type 2 diabetes are independent risk factors of severe illness in patients with COVID-19. Funding Statement: None. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The study was approved by the institutional ethics board of these hospitals, with a waiver of informed consent.