Demographics, baseline and clinical characteristics of COVID-19 pneumonia patients (table 1)
In our study, 74 (43.7%) patients had a clear history of living in Wuhan before the onset of the disease, including Wuhan locals and those working, studying, traveling or working in Wuhan. These patients who were infected with the virus in Wuhan were regarded as imported patients, while the rest were regarded as local patients. There was no medical staff in our patients.
The median age of all patients was 45 years (interquartile range, 34.5 to 55). The median age of imported patients was 45 years, and local patients was 43 years. The age of the patients was mainly between 19 and 49 years old (67.6% of imported patients and 58.9% of local patients). The proportion of local patients over 50 years old (41%) was slightly higher than that of imported patients (32.5%). There is no significant difference in gender between two groups. The male-to-female ratio of all patients was close to 1/1, which was consistent with the study of Wu et al.
On admission, body temperature in most of patients (62.2% VS 77.9%) was lower than 37.3 ℃. Among the fevers, most of them were slight fever, and only 1 case had high fever (＞40℃). The incidence of fever in imported patients (37.9%) was significantly higher than that in local patients (22.1%). P=0.065.
The abnormal physical signs of pulmonary auscultation were mainly crackles or mixed crackles and stridor. The proportion of abnormal pulmonary signs was significantly higher in imported patients (10.9% VS 4.2%). And only 3 of imported patients were complicated with mixed crackles and stridor, while none of local did.
Among all of the patients, 31.4% had at least one complication. Compared with local patients, more patients with underlying disease in imported patients (35.8% VS 25.7%), but no statistically significant was found. The top three underlying diseases were hypertension (8.1% VS 13.7%), diabetes (5.4% VS 9.5%), and cardiovascular and cerebrovascular diseases (2.7% VS 8.4%).
In this study, cough (86.5% VS 75.8%), fever (78.4% VS 68.4%) and fatigue (both 43.2%) were still the three most common clinical symptoms of COVID-19 pneumonia. However, the proportion of gastrointestinal symptoms (such as nausea, vomiting, diarrhea, etc.) was also close to 1/3 (29.7% VS 32.6%), which is not as low as the previous study. But no significant was observed between two groups.
In addition, the median onset-visit interval of both imported and local patients was 3 days, and there was no significant difference.
Radiographic findings of COVID-19 patients (table 2)
On admission, radiographs results showed that 130 of the 166 patients (78.3% VS 78.1%) had ground-glass opacity (GGO), and 21 of the 166 patients (13.7% VS 11.8%) had mixed GGO and consolidation. Only 1 patient had consolidation only. Besides, the proportion of bilateral pneumonia was higher in imported patients (84.9% VS 79.6%) while the proportion of unilateral pneumonia was higher in local patients (8.2% VS 14.0%). However, no significant difference was observed.
After a period of treatment, the proportion of patients with only GGO decreased (54.2% VS 46.2%), while the proportion of mixed GGO and consolidation patients increased (29.2% VS 35.2%), which conform natural outcome of lung imaging performance.
Laboratory results of COVID-19 patients (table 3)
The leukopenia accounted for 22.6% (25.7% VS 20.2%), lymphocytopenia 47.6% (48.6 VS 46.8%), Hemoglobinopenia 24.4% (20.3% VS 27.7%), thrombocytopenia 14.3% (16.2% VS 12.8%), but there was no significant difference between two groups at admission.
The proportion of APTT (median 12.1s) shortening in imported patients was significantly lower than that in local patients (median 11.7s). On the contrary, the proportion of increased D-dimer in imported patients was significantly higher (35.1% VS 25.8%)，P values＜0.1.
The results of blood gas analysis in the two groups were similar. 68.6% of the patients had alkalosis, while 28.3% of the patients had a decrease in PaO2 and 37.1% had a decrease in PaCO2. No significant difference was found.
Most patients had hypoalbuminemia (62.2% VS 51.6%), of which the albumin level of imported patients (median 37.87g/L) is lower than that of local patients (median 39.64g/L). The prevalence of abnormal serum ALT and AST was about 23%, while that of CK and CK-MB was less than 10%, but there was still no significant difference.
There was a significant difference in hyponatremia (25.7% VS 11.6%) and p value is 0.025. Besides, the median serum potassium and median serum sodium of imported patients (3.95mmol/L and 137.0mmol/L) were significantly lower than those of local patients (4.15mmol/L and 137.8mmol/L), while the proportion of blood glucose rise was significantly higher than that of local patients (50% VS 34%)，p＜0.1。
In addition, CRP was elevated in more than half of the patients (58.1% VS 50.5%). The median CRP of imported patients was 12.71mg/L, while the median CRP of local patients was 9.92mg/L, but there was no statistical difference. Surprisingly, only 3 patients had increased PCT.
Complications, treatments and clinical outcomes of COVID-19 patients (table 4)
The moderate type was the most common (70.3% VS 82.1%), followed by severe, mild, and critically type. The proportion of severe type of imported patients (20.3%) was significantly higher than that of local patients (9.3%), while the proportion of moderate type was significantly lower (70.3% VS 81.4%), p＜0.1.
During the hospitalization, 18 patients had severe complications, such as ARDS, Shock, AKI, and MODS. The incidence of ARDS (12.2% VS 7.4%) in imported patients was higher than that in local patients. Shock only occurred in imported patients (2.7%). 20 patients were admitted to the ICU, of which 13.5% were imported patients and 10.5% were local patients. Oxygen therapy was administered in about 95% patient in both two groups, and only 2 patients were treated with ECMO, and 1 case was treated with continuous renal replacement therapy, all of which were imported patients. No statistically significant difference was observed.
All patients received antiviral therapy during hospitalization, with about 1/4 using a single drug and 3/4 using a combination. The most commonly used antiviral drugs were Lopinavir/Ritonavir, interferon and Arbidol.
Using antibiotics, glucocorticoids, and gamma globulin were significantly higher in imported patients than in local patients (60.8% VS 44.2%, 36.5% VS 17.9%, 36.5% VS 17.9% respectively), P ＜0.05. The type of glucocorticoid was methylprednisolone, with the usual initial dose of 40mg, and the maximum dose of 80mg. Glucocorticoids and gamma globulin were not used unless a panel discussion by experts considered necessary (e.g., ARDS). The median course of treatment of the glucocorticoid was 7 days, while the median course of gamma globulin was 6 days. Besides, the median viral clearance duration in imported patients was significantly longer than that in local patients (11 days VS 9 days), p is 0.080.
As of March 2, 2020, a total of 154 patients were discharged, 1 died (imported case), and 14 (1 imported case and 13 local patients) were still in hospital. Since Wuhan was closured on 23 Jan., there were no more imported patients after 5 Feb., so the patients admitted to the hospital at the later stages were local patients. The median length of hospital stay was 13 days.