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24 maart 2020

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China - JAMA

Bron: https://jamanetwork.com/journals/jama/fullarticle/2761044

By: D. Wang, B. Hu, C. Hu

Aim
What are the clinical characteristics of hospitalized patients with 2019 novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) in Wuhan, China?

Key

  • 26% of admitted patients require ICU care
  • Median 7 days from onset of symptoms to hospital admission and 10 to ICU
  • Common symptoms at onset of illness were fever, dry cough, myalgia, fatigue, dyspnea, and anorexia. However, a significant proportion of patients presented initially with atypical symptoms, such as diarrhea and nausea. 
  • Major complications during hospitalization included ARDS, arrhythmia, and shock. 
  • Bilateral distribution of patchy shadows and ground glass opacity was a typical hallmark of CT scan. 

Summary

  • Clinical characteristics of 138 PCR proven covid19 patients in a Wuhan university hospital were described. 
  • Median age: 56 years (range 22-92). 54.3% men. 
  • 26.1% of patients admitted to the ICU. 
  • Resp. 7, 8, and 10 days from onset of symptoms to hospital admission, ARDS, ICU admission
  • 54% of patients without comorbidity. 
  • Most common symptoms at onset; fever [98.6%], fatigue [69.6%], dry cough [59.4%], myalgia [34.8%], and dyspnea [31.2%]. Less common symptoms were headache, dizziness, abdominal pain, diarrhea, nausea, and vomiting.
  • 41% were presumed to have been infected in the hospital of whom 29% was hospital personnel. Prevention of spread is key! Including a lot of surgical personnel since one patient was admitted with abdominal pain without further symptoms!
  • ICU patients were older, more comorbidities, and more often reported: pharyngeal pain, dyspnea, dizziness, abdominal pain, and anorexia.
  • ICU patients had higher white blood cell count, higher d-dimer, and higher creatine kinase at presentation.  
  • All patients (100%) show bilateral involvement on chest CT.
  • At follow-up of 5 to 35 days, 4.3% of patients had died (so probably underestimation)
  • ICU complications and treatment:
  • Course of laboratory findings in survivors vs non-survivors: