Changes in the clinical characteristics of severe Corona Virus Disease 2019 in Jiangxi Province

Backgrounds: To determine the differences in clinical manifestations and biomarker levels of Corona Virus Disease 2019 (COVID-19) patients, including common patients and severe (serious and critical) patients. Methods: A total of 89 COVID-19 patients were diagnosed and treated at the First Aliated Hospital of Nanchang University. We clinically classied the patients and collected data. Findings: There was a higher proportion of conrmed cases in patients with type A blood (44.8%). There were no obvious differences in number of lung lobes involved in the lesion between the patients with or without a positive nucleic acid test (p>0.05).There were obvious differences in contact history (p<0.001), duration of symptoms (p=0.004), and respiratory rate (p=0.029) between the patients with or without a positive nucleic acid test. According to the results of the nucleic acid diagnosis test, there were no obvious differences in the number of lung lobes involved in the lesion and all items of routine blood, liver, and kidney function tests between the patients with or without positive nucleic acid tests (all p>0.05). Between the common patients and severe patients, there were obvious differences in age (p=0.006), duration of symptoms (p=0.001), diastolic blood pressure (p=0.046), lymphocyte count (p (cid:0) 0.0001), neutrophil count (p=0.019), albumin (p=0.002), lactate dehydrogenase (p=0.007), calcium (p (cid:0) 0.0001), C-reactive protein (CRP) (p=0.004), erythrocyte sedimentation rate (p=0.021), international standard ratio (p=0.020), and CD3 (p=0.001), CD3+CD4 (p=0.006), and CD3+CD8 (p=0.001) levels. In patients infected with SARS-COV-2, the number of lung lobes involved in the lesion were positively correlated with lymphocytes (R=0.261, p=0.044); the body mass index (BMI) values were positively correlated with the number of lung lobes involved in the lesion (R=0.320, P=0.034); the age (R=0.391, p<0.001) and respiratory rate (R=0.352, p=0.001) were positively correlated with neutrophil count; and the age (R=0.349, p=0.001) and the number of lung lobes involved in the lesion (R=0.422, p=0.001) were positively correlated with CRP.

In order to study COVID-19, we collected the data from 89 patients diagnosed in our hospital, analyzed their symptoms, signs, complications, and cytokines, and subsequently reported the results.

Subjects and study design
A total of 89 cases of COVID-19 were diagnosed and treated at the First A liated Hospital of Nanchang University, including 56 common patients, 22 severe patients (including serious patients and critical patients), and 11 suspected patients ( Figure 1).
The purpose of this study is to determine the differences in clinical manifestations, typing, and biomarker levels in common and severe COVID-19 patients. This study was carried out according to the Declaration of Helsinki, and the plan was approved by the ethics committee of the First A liated Hospital of Nanchang University (ethics No.: 2020013). All methods were carried out to the extent permitted by relevant guidelines and regulations. The inclusion criteria of COVID-19 patients meet any of the following: (1) real-time uorescent reverse transcription-polymerase chain reaction (RT-PCR) detection of new coronavirus nucleic acid isolated from respiratory or blood samples; (2) virus gene sequences from respiratory or blood samples that are highly homologous with the known new coronavirus. All procedures were repeated more than twice, with an interval of more than 24 hours.

Figure 1
Clinical classi cation (1) Common patients: with fever, respiratory tract and other symptoms, pneumonia con rmed via imaging.
(3) Critical patients: those who meet one of the following conditions: (A) respiratory failure and require mechanical ventilation; (B) shock; (C) other organ failure requiring intensive care unit (ICU) monitoring and treatment.

Data collection
All subjects provided their informed consent before participating in the study. Body mass index (BMI), incubation period, temperature, pulse frequency, systolic blood pressure, diastolic blood pressure, and other clinical data were obtained through detailed physical examination and medical history inquiry.
Routine blood tests and tests for liver function, kidney function, in ammatory index, coagulation function, and lymphocyte count were performed in the laboratory.

Statistical analysis
The chi-square test and t-test were used to compare the basic clinical characteristics of the two groups, such as age, gender, and clinical classi cation. Then, the levels of various cytokines, electrolyte and blood gas analysis results, liver function, renal function, routine blood tests, coagulation function, myocardial enzyme spectrum, and immunology indexes of different groups were analyzed to determine whether there were differences between the two groups. P<0.05 indicates statistical signi cance. Spearman rank-order correlation was used to evaluate the relationship among the parameters (items of clinical features) that were not normally distributed, and Spearman's correlation coe cient (ρ) was reported. The chi-square test was used to assess associations among categorical variables including gender and potential confounding factors. Additionally, p < 0.05 was considered statistically signi cant.

Results
Demographics and visual measurements Figure 1 shows the characteristics of patients infected with SARS-COV-2. Whether in common patients or critical patients infected with SARS-COV-2, there was a higher proportion of con rmed cases in patients with type A blood. Figure 2 shows computed tomography (CT) images of the lungs of COVID-19 patients at different stages. According to the results of the nucleic acid diagnosis test, there were no obvious differences in sex, age, BMI, incubation period, temperature, pulse frequency, systolic blood pressure, diastolic blood pressure, or number of lung lobes involved in the lesion (all p>0.05) between the patients with or without positive nucleic acid tests. Therefore, the number of lung lobes involved in the lesion may not be a valid criterion for COVID-19 diagnosis. There were obvious differences in contact history (p<0.001), duration of symptoms (p=0.004), and respiratory rate (p=0.029) between the patients with or without positive nucleic acid tests (Table 1, Figure 2).
For con rmed patients, there were no obvious differences in sex, BMI, contact history, incubation period, duration of symptoms, temperature, pulse frequency, respiratory rate, systolic blood pressure, or number of lung lobes involved in the lesion when comparing common and severe patients (all p>0.05). There were obvious differences in age (p=0.006), duration of symptoms (p=0.001), and diastolic blood pressure (p=0.046) between common and severe patients. (Table 1) Table 1 Figure 2 Laboratory ndings Between the patients with or without a positive nucleic acid test, there were no obvious differences in all items from routine blood tests and liver and kidney function tests. Details are presented in Table 2.
Host range and tissue tropism vary greatly among different coronaviruses. In general, thyroid coronavirus and β-coronavirus can infect mammals, and gamma coronavirus and triangular coronavirus can infect birds, but some of these viruses can also infect mammals (Cui et (Table 4). Table 4 In the study by  There are many vaccine strategies for CoV. Inactivated, attenuated, and live viruses, viral vector-based vaccines, subunit vaccines, recombinant proteins, and DNA vaccines have been developed, but thus far, only animals have been tested. (Graham et al., 2013) Currently, there is no effective treatment or vaccine, and therefore, the most e cient methods to manage SARS-COV-2 infection are to control the source of infection, early diagnosis, reporting, isolation, supportive treatment, and timely release of epidemic information to avoid unnecessary panic. For individuals, good personal hygiene, appropriate masks, ventilation, and avoiding crowded places will help to prevent SARS-COV-2 infection.
To more closely study this new virus, in 2019, we examined the data from 42 patients diagnosed in our hospital, analyzed their symptoms, signs, complications, and cytokines, and then reported the results.
Through serological examination of COVID-19 patients, we found that patients exhibited a signi cant decrease in CD3, CD4, and CD8 compared with ordinary people, and the levels of CD3, CD4, and CD8 in severe patients were lower than those in common patients. We speculate that SARS-COV-2 and cellular immune response, and especially T cells, are closely related. 2019-nCoV may inhibit T cell function in the body, cause T cell dysfunction, and reduce the levels of CD3, CD4, and CD8. As the patient's immunity decreases and the greater the degree of decline, the more serious the patient's condition.
We also found that in the imaging examination of patients, there was no difference in the number of lesions in common patients compared with severe patients, and the average cumulative number of lung lobes was the same as that in severe patients. Therefore, it is unlikely that the number of lesions detected by imaging can be regarded as ordinary in common patients and severe patients.
Ultimately, we found that patients with blood type A accounted for 44.9% of all patients, which is signi cantly higher than patients with other blood types. We could not locate any previous studies that mentioned that patients with blood type A are more susceptible to SARS-COV-2. Therefore, we require a larger sample size to explore this inherent relationship.
Our study has some limitations. The limited number of cases when collecting samples led to a small number of samples, and some unknown variables may affect the experimental results. Most SARS-COV-2 patients are related to Wuhan. In addition to known variables (such as eating wild animals), there are also unpredictable variables, such as regional differences and customs differences, which may affect the experimental results.

Con ict of Interests
This was not an industry supported study. The authors report no con icts of interest in this work.

Figures
Only small ground glass shadow was seen in the upper left lobe, with unclear boundary. B. In the progressive stage, multiple patchy, large ground glass shadows and consolidation shadows can be seen, and even pleural effusion can be seen. C. As for severe patients, diffuse lesions of both lungs may increase by 50% or even appear pulmonary brosis.   Ways and symptoms of a viral infection. Figure 5: 2019-nCoV can be transmitted into the lungs through the air, aerosol transmission or through contact with the conjunctiva, causing multiple system dysfunctions such as the endocrine system, the respiratory system, etc.

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