Clinical features and treatment of COVID-19 patients in northeast Chongqing
Wan S, Xiang Y, Fang W, et al. Clinical features and treatment of COVID-19 patients in northeast Chongqing [published online ahead of print, 2020 Mar 21]. J Med Virol. 2020;10.1002/jmv.25783. doi:10.1002/jmv.25783
Review written by:
Yucong Wang, edited by Diogo Teles, MD and Robert Parry
Green - retrospective, single-center case series (135 patients), largest case series of COVID-19 in Chongqing at time of publication.
This study retrospectively collected the clinical data of 135 patients from 01/23/20 to 02/08/20 and divided them into mild or severe group based on if they met criteria for a severe case: RR ≥ 30/min, SaO2 ≤ 93%, OR PaO2/FiO2 ≤ 300 mm Hg. . 29.6% of patients were put in the severe group.
Demographic characteristics: Mean age of all the patients was 47 years and 53.3% were male. Severe patients were significantly older and were significantly more likely to have comorbidities. Diabetes (22.5%), cardiovascular disease (15%), hypertension (10%) and malignancy (7.5%) were the most common comorbidities in the severe group.
Clinical presentation: Fever (88.9%), cough (76.5%), myalgia or fatigue (32.5%), pharyngalgia (25.2%) and headache (24%) were the most common symptoms. Dyspnea (13.3%), diarrhea (13.3%), and shortness of breath (8.8%) were also observed.
Laboratory results: Leukocyte counts of most patients were in the normal range but the lymphocytes were significantly lower in the severe group suggesting that the virus may be attacking the immune system. PT, APTT and D-dimer were significantly higher in severe patients suggesting a hypercoagulable state. The level of albumin was significantly lower in severe patients. LDH and procalcitonin of severe patients were significantly higher than those of the mild patients.
Imaging: A chest CT scan was performed in all patients. The most common changes were interstitial pneumonia with bilateral involvement and multiple patchy, flocculent or strip ground-glass shadow. The margins were ill-defined and there was little pleural effusion. In some patients, symptoms were mild, and multiple nucleic acid tests were negative, the CT showed a large ground glass area in the lung, the “shadow‐syndrome discrepancy.”. In severe cases, consolidation of the lungs could occur.
Complications: The most common complications included ARDS (15.6%), acute cardiac injury (7.4%), acute kidney injury (3.7%), secondary infection (5.1%) and shock (0.7%).
Treatment: All of the patients received antiviral therapy (Lopinavir and Ritonavir), 43.7% of the patients received antibacterial therapy, and 26.7% received corticosteroids. 67.5% of the severe patients received noninvasive ventilation. Traditional Chinese Medicine (TCM) therapy was applied in 91.8% of the patients.
Outcome: 11.1% of patients were discharged and one patient died. The 28-day mortality rate was 2.5%.
Traditional Chinese medicine primarily included Renduning injection, Suhuang Zhike capsule and Xuebijing, as well as Chinese herbs including glycyrrhiza, ephedra, bitter almond, gypsum, reed root, amomum and trichosanthes.
The sample size was relatively small and only from one hospital.
Most of the 135 patients were still hospitalized at the end of this study, which made it difficult to evaluate the risk factors for a poor prognosis and true mortality rate.