Clinical characteristics of survivors and non-survivors, medical and non-medical staff members with 2019nCoV pneumonia in Wuhan, China: a descriptive study

Objectives: In December 2019the 2019 novel coronavirus ( 2019-nCoV ) emerged in Wuhan, China, leading to a cluster of severe pneumonia cases. Medical staff members on the front line were also infected. We compared the epidemiology, clinical characteristics, and treatment measures of survivors and non-survivors and the different clinical outcomes of medical staff members and non-medical members of the community infected with 2019-nCoV. Methods: We included 81 patients with adult 2019-nCoV in Hankou Hospital from mid-January to mid-February 2020 in this single-center retrospective study. Data were compared between survivors and non-survivors and between medical staff members and non-medical individuals. Results: All 38 medical staff members were infected by patients while working. Only 2 (2.5%) non-medical individuals had a clear history of exposure to 2019-nCoV patients. The median age was 49 years (interquartile range [IQR], 35-59; range, 23-89 years), and 42 (51.9%) were women. We found that the median age,comorbidity, and some laboratory outcomes(lymphocyte count, urea nitrogen, aspartate aminotransferase, lactate dehydrogenase, etc.)differed significantly between survivors and non-survivors. There were also significant differences in the time from onset to admission, disease classification, comorbidity, and prognosis between medical staff members and non-medical individuals. All medical staff members were cured, while 13 (30.2%) non-medical individuals died. Conclusions: Older males with comorbidities are more likely to be affected by 2019-nCoV. Significant changes in some laboratory markers may indicate a poor prognosis. Medical staff members may have had better prognoses due to fewer comorbidities and better medical compliance. 2019-nCoV: 2019 novel coronavirus; AST: aspartate aminotransferase; ALT: alamine aminotransferase; LDH: lactate dehydrogenase; PCT: procalcitonin; NT-proBNP: N-Terminal pro-brain natriuretic peptide; CTnI: Cardiac troponin I; CT: computed tomography; ICU: Intensive care unit; IQR: Interquartile ranges; SPSS: Statistical product and service solutions.


Introduction
Since December 2019, several cases of unexplained pneumonia were discovered in hospitals in Wuhan, Hubei province, China. These cases were later confirmed to be novel coronavirus-infected pneumonia, caused by a new type of coronavirus (2019-nCoV) [1][2][3]. This 2019-nCoV pneumonia has now been included among the Class B infectious diseases stipulated in the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases and has been managed according to the Class A guidelines. The characteristics of 2019-nCoV include strong infectivity, a long incubation period, complex transmission channels, and diverse clinical characteristics [3]. Most patients have mild fever, a non-productive cough, myalgia, dyspnea, or fatigue at the onset of the disease. In severe cases, infection can lead to pneumonia, acute respiratory distress syndrome, multiple organ failure, and even death. As of March 31, 2020, more than 82,000 2019-nCoV pneumonia cases had been confirmed in China, and more than 700,000 cases had been reported in other countries.
Vaccination is the most effective strategy to prevent and control virus infection. However, there is no vaccine specifically for 2019-nCoV. Apart from antiviral drugs such as lopinavir and ritonavir, the main clinical treatment is still symptomatic and supportive treatment.
We aim to describe the epidemiological, demographic, and clinical data of patients with 2019-nCoV infection and compare clinical characteristics between survivors and non-survivors and between medical staff members and non-medical members of the community. We hope that our findings will provide a scientific basis for further prevention and treatment of 2019-nCoV pneumonia.

Study design and participants
We recruited 81 patients admitted to Hankou Hospital in Wuhan from mid-January to mid-February 2020 in this single-center, retrospective study. The medical team of Changzheng Hospital, which supports Hankou Hospital, has been assigned by the government to provide treatments for 2019nCoV pneumonia. All included patients were diagnosed with 2019-nCoV pneumonia according to interim guidance from the World Health Organization, and patients with inadequate clinical information were excluded. The 81 admitted patients included 38 medical staff members infected with 2019-nCoV while providing first-line treatments. We collected all available electronic medical records, nursing records, and patient data for the analysis. The study was approved by the ethics committees of Hankou Hospital (HKYY-2020-022) and Changzheng Hospital (2020SL009), and written informed consent was obtained from all of the patients or their next of kin.

Data collection
Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed that the patients included in this study were infected with 2019-nCoV. We reviewed the demographic, epidemiological, laboratory, radiological, treatment, and prognosis data from the patients' medical records and followed their clinical outcomes until Feb 27, 2020. The collected data included name, gender, age, work, time of onset, time of treatment, time of hospitalization, exposure history, comorbidities (hypertension, coronary heart disease, diabetes, tumor, other chronic diseases), symptoms (fever, cough, fatigue, dyspnea, headache, sore throat, diarrhea), laboratory indicators, chest computed tomography (CT) scans, medication (antiviral drugs, glucocorticoids, immunoglobulin, antibiotics), disease classification, and prognosis. Three physicians checked all the data carefully (HJX, MYS and WKC).

Outcomes
We statistically analysed epidemiological data (i.e., living near or engaged in short-or long-term work near the Huanan seafood market, where the outbreak likely originated; history of patient exposure), demographics, symptoms at admission, comorbidities, infection of other respiratory pathogens, laboratory indicators, results of chest CT scans, medication treatment, disease classification, and prognosis.

Statistical analysis
Normally distributed continuous variables were presented as the mean (standard deviation [SD]). If not normally distributed, they were expressed as the median (interquartile range [IQR]). Categorical variables were expressed as the number (%). The two-sample t test was used to assess the differences between survivors and non-survivors and between medical staff members and nonmedical individuals if the data of continuous variables was parametric; if not, the Wilcoxon rank-sum test was used. Fisher's exact test was used for categorical variables. We will double check the laboratory indicators. SPSS (version 26.0) was utilized for all analyses.

Results
As of February 15, 2020, 81 patients diagnosed with 2019-nCoV pneumonia at Hankou Hospital were included in the study. All of them were residents of Wuhan City, including the 38 medical staff members infected by patients while working. Among the 38 medical staff members, 31 were from Hankou Hospital and 7 were transferred from other hospitals. Forty-three non-medical individuals did not have a clear history of direct exposure to the Huanan Seafood Market, but 2 (2.5%) had been exposed to confirmed or highly suspected 2019-nCoV infections. The median age of all patients was 49 years (IQR, 35-59; range, 23-89 years), and 42 (51.9%) were women. There were no children or adolescents among the included patients. The median time from onset to hospital admission or medication was 5 days (IQR, [3][4][5][6][7][8][9]. Almost all patients were admitted one day after their chest CT results came back positive, and they began receiving medication once admitted. Among  were negative. The most common symptoms at onset were fever (85.2%), cough (54.3%), and fatigue (33.3%). Other symptoms included dyspnea (14.8%), sore throat (6.2%), headache (4.9%), and diarrhea (4.9%). All patients were diagnosed with unilateral or bilateral typical changes in a chest CT, including patch and cloud-like infiltration shadows or ground glass opacity. In the routine blood test performed upon admission, the leucocyte count was lower than normal in 23 (28.4%) patients, and the leukomonocyte count was lower than normal in 48 (59.3%). The platelet count was lower than normal in 14 (17.3%) cases, while the C-reactive protein level was higher than normal in 52 (67.9%).
Our results revealed significant differences between medical staff members and non-medical individuals in the time from onset to admission (Figure 4), comorbidity, disease classification, and prognosis. The median time for medical staff members from onset to admission or medication was 3.5 days (IQR, 2-5 days), while that for non-medical individuals was 7 days (IQR, 4.5-10 days). Moreover, medical staff members had fewer comorbidities. Most medical staff members (86.8%) were diagnosed with common pneumonia, while most non-medical individuals (41.9%) were diagnosed with critical pneumonia. All of the medical staff members were cured, while 13 (30.2%) of the non-medical individuals died (all the data is in Table 2).

Discussion
In this descriptive study, we report the clinical features of 81 patients with laboratory-confirmed 2019-nCoV infection at Hankou Hospital in Wuhan, China. We examined the epidemiological, demographic, clinical, laboratory, radiological, treatment, and prognosis factors of survivors and nonsurvivors and of medical staff members and non-medical individuals.
We compared the medical records and laboratory data of survivors and non-survivors. The median age of non-survivors was 69, which was 27 years older than that of survivors. Old age can be considered a risk factor for death, as reported elsewhere [4]. The mortality rate was higher in patients with hypertension, diabetes, coronary heart disease, or a combination of these. Studies have shown that poor glycemic control has an important effect on infection-related mortality [5] and may be associated with impaired immune function in diabetic patients [6,7]; there is evidence that better glycemic control improves immune mechanisms and reduces susceptibility and severity of infection [8,9]. Most of the included patients were admitted with a fever and cough; some also had fatigue and dyspnea. There were no statistically significant differences between survivors and non-survivors in the first symptoms or in the course of disease before admission. Lymphocytes decreased significantly in all of the 2019-nCoV patients, and there were fewer lymphocytes in non-survivors than in survivors, which is similar to previous reports [10,11]. The increase of C-reactive protein, lactate dehydrogenase, D-dimer, and procalcitonin showed a similar trend; the values of non-survivors were higher. These markers are also risk factors for prognosis.
In terms of treatment, different kinds of antiviral drugs were consumed before admission and in mild illness. Supportive glucocorticoid and immunoglobulin treatments were used for most patients, and there was no significant difference in treatment between those who died and those who were cured.
Despite the various treatments available, 13 patients died; the median time from admission to death was 15 days (IQR, 11-21 days), and the chest CT scans showed rapid deterioration (Fig. 5).
In this study, more than 80% of the medical staff members were diagnosed with common pneumonia, Above are the main points of our study.

Conclusion
Our study was different from previous studies because of the comparison between medical staff members and non-medical staff individuals. Medical staff members are the main force in the fight against the epidemic of 2019-nCoV, they had better prognoses due to timely detection and treatment, young age, fewer comorbidities, and better medical compliance. Only when the medical staff members pay more attention to themselves and do a good job of protection, can it be more conducive to the treatment of patients with 2019-nCoV pneumonia and the prevention and control of 2019-nCoV.
Previous cardiovascular disease or diabetes, and advanced age, were potential risk factors for death.
And some important blood test indicators like PCT, LDH, Leukomonocyte count, C-reactive protein, Ddimer, Urea nitrogen, and AST had statistical difference between survivors and non-survivors, as well as other indicators like Platelet count, Albumin, NT-proBNP, and CTnI. These results are similar to previous studies, which can provide a basis for possible trends in disease.
In summary, fewer comorbidities, timely medical treatment and compliance with the doctor's instructions are helpful to the recovery of the disease to a large extent. Significant changes in some laboratory markers may indicate a poor prognosis. More related studies are needed in the future. We hope that our findings will provide a scientific basis for further prevention and treatment of 2019-nCoV pneumonia.

Figure 2
Comparison between non-survivors and survivors in Lymphocytes count.

Figure 3
Comparison between non-survivors and survivors in LDH.

Figure 4
Comparison between medical staff and non-medical staff in the time from onset to admission or medication.