Infections with the 2019 novel coronavirus (2019-nCoV) was of clustering onset and more likely to affect older men with comorbid diseases, according to a study published in The Lancet. 2019-nCoV infection can result in severe and fatal respiratory diseases; mortality risk was consistent with the MuLBSTA scores used to predict mortality in viral pneumonia.
The investigators of this retrospective, single-center study sought to describe the epidemiologic and clinical characteristics of 2019-nCoV pneumonia using data from cases at the Jinyintan Hospital in Wuhan.
The study sample included all 99 patients with confirmed 2019-nCoV at the Wuhan Jinyintan Hospital between January 1, 2020 and January 20, 2020. Real-time reverse transcription-polymerase chain reaction was used to detect the virus, and laboratory confirmation of 2019-nCoV was performed in 4 different institutions. All patients underwent chest radiographs or chest computed tomography, and sputum or endotracheal aspirates were collected to identify causative bacteria or fungi. Patients’ medical records were analyzed for further epidemiologic, demographic, clinical, radiologic, and laboratory data. Patients were followed until January 25, 2020.
The average age of patients with 2019-nCoV was 55.5 years, and the sample included 67 men and 32 women. Of 99 participants, 49 patients were clustered and had a history of exposure to the Huanan seafood market. Roughly half (51%) of the patients reported chronic comorbidities, including cardiovascular and cerebrovascular diseases, endocrine system disease, digestive system disease, respiratory disease, nervous system disease, or malignant tumor.
Upon admission, patients reported several clinical manifestations, including fever (83%), cough (82%), shortness of breath (31%), muscle ache (11%), confusion (9%), headache (8%), sore throat (5%), rhinorrhea (4%), and chest pain (2%). Several patients presented with organ function damage, including acute respiratory distress syndrome (17%), acute respiratory injury (8%), acute renal injury (3%), septic shock (4%), and ventilator-associated pneumonia (1%).
On imaging examinations, 75% of patients showed bilateral pneumonia, 25% showed unilateral pneumonia, 14% showed multiple mottling and ground-glass opacity, and 1% showed pneumothorax. In laboratory results, the absolute number of lymphocytes was reduced in most patients, suggesting that 2019-nCoV acts on lymphocytes. Patients’ immune response to the virus signaled further changes in peripheral white blood cell and immune cell counts.
Most patients (76%) received treatment with an antiviral for a median of 3 days. Antivirals used were oseltamivir (75 mg every 12 hours, orally), ganciclovir (0.25 g every 12 hours, intravenously), and lopinavir and ritonavir tablets (500 mg twice daily, orally).
A total of 25 patients received treatment with a single antibiotic and 45 of patients were given combination therapy. The antibiotics used covered common pathogens and some atypical pathogens; in the case that secondary bacterial infection was confirmed, antibiotics we adjusted according to the results of bacterial culture and sensitivity.
A total of 13 patients received noninvasive ventilator mechanical ventilation for a median of 9 days and 4 patients required an invasive ventilation for a median of 17 days.
At data cutoff, mortality was reported in 11% of the sample, whereas 31% of the patients had been discharged. The remaining patients were still in the hospital as of January 25; additional deaths may have occurred in this group. In the first 2 patients who died, the disease progressed rapidly; the time between symptom onset and use of ventilator-assisted breathing occurred in a range of 3 to 10 days. Mortality was preceded with the development of severe pneumonia and acute respiratory distress syndrome and, finally, multiorgan failure. In fact, mortality associated with 2019-nCoV was consistent with the MuLBSTA score, a model developed to predict mortality in viral pneumonia.
Limitations to the study included the retrospective design in which detailed patient information was unavailable, especially regarding clinical outcomes, and the relatively small study population, which included only patients from Wuhan.
The investigators suggested that 2019-nCoV infection was more likely to affect older men with chronic comorbidities, such as hypertension, and an important epidemiological feature included clustered onset. Mortality from 2019-nCoV was associated with the rapid development of severe respiratory diseases; future studies should explore the use of MuLBSTA scores in predicting mortality risk in 2019-nCoV infection.
Chen N, Zhou M, Dong Z, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507-513.