Clinical Features of 35 COVID-19 Patients with Hospitalization for More than 20 Days

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Background
Since December 2019, researchers have found SARS-CoV-2 has strong affinity to human respiratory receptors and that humans are generally susceptible to it, which causes sustained human-tohuman transmission and seriously threatens human health [1][2][3][4].
The patients infected with SARS-CoV-2 in Guizhou province are apparently mild in contrast to those originally infected in Wuhan in 2020.However, SARS-CoV-2 was named as severe acute respiratory syndrome coronavirus with a certain mortality rate especially in critically ill patients [5,6], so more attentions should be paid to this kind of disease.
As we know, some of the confirmed patients may stay longer in the hospital for some reasons, but whether the different hospitalization days are associated with different clinical features or different outcomes is not clear yet.In addition, although the conventional antiviral therapy is administered in time, some of patients' nucleic acid tests continuously show positive or return back to positive again, so how to take the next step is still a question.Here, we introduce the clinical features and the antiviral

Statistical analysis
All data were analysed by SPSS software (version 20.0).We described categorical variables as percentages and continuous variables as medians with interquartile ranges, or means and standard deviations.

Discussion
Since an outbreak of pneumonia caused by SARS-CoV-2 was reported in December 2019, many researchers have found that SARS-CoV-2 can cause sustained human-to-human transmission in other areas, thus resulting in global outbreak with a certain mortality rate, seriously threatening human health [7][8][9][10][11].
This study showed that of the 97 confirmed patients, only 4 had been admitted to the intensive care unit, and no patients died.6 patients' nucleic acid tests were confirmed to return to positive again after discharge from the hospital, but they had no any symptoms at that time, who continued to receive antiviral therapy and the nucleic acid test turned negative again within 10 days.In this study, only 8 confirmed patients had been to Wuhan city.Most of them were infected by family gathering or close contact with patients confirmed with SARS-CoV-2 infection [12].
Of all the patients, the most common symptoms were fever (39.2%), cough (48.5%), sputum production (29.9%) and diarrhea (19.6%); most of them were regarded as mild and moderate type, but some had organ function injury, including ARDS, acute cardiac injury, and acute liver injury.Only 4.1% patients had been admitted to ICU.All the patients were discharged and no one died.Compared with those initially infected with SARS-CoV-2 in Wuhan, patients in Guizhou province had milder symptoms, better prognosis and lower mortality [13,14] indeed.
In this study, 46.4% of patients were treated with dual antiviral therapy, 24.7% with triple antiviral therapy, and 23.7% with quadruple antiviral therapy.Therefore, combination of antiviral therapy was major choice.
In our province, most of the COVID-19 patients had stayed in hospital for more than 10 days, so we divided the cohort into two groups: patients with hospitalization for more than 20 days (Group 1) and those with hospitalization for less than 20 days (Group 2).To our knowledge, this is the first time we compared the clinical data between the two groups above at home and abroad.
Compared with Group2, Group1 had more acute respiratory distress syndrome, hospital-acquired infection as secondary infection, suggesting that these two complications may lead to longer stay in hospital; more patients received quadruple antiviral therapy, antibiotic therapy and immune enhancer in Group 1, so we think longer hospitalization is usually accompanied by more powerful treatment.In Group1, 2 patients were treated by convalescent plasma therapy and high-flow nasal cannula, with 1 administered plasma exchange [4].Patients had been admitted to ICU. 14.3% of the patients had the nucleic acid tested after discharged from hospital, which showed positive again.So, we think those repeated positives are common in patients with longer stays in hospital.
Compared with Group2, Group1 had lower oxygenation index and higher percentages of leucopenia, lymphopenia, C-reactive protein≥8mg/L and procalcitonin≥ 0.5ng/ml, suggesting that higher severity of disease is one of reasons for the longer hospitalization days and that inflammation may be a factor of discharge delays.
In contrast to those of Group2, the percentages of D-dimer and alanine aminotransferase ≥40U/L were higher in Group1, which is consistent with some related studies that higher levels of D-dimer and aminotransferase were associated with severity of disease in critically ill patients [15,16].
It is noteworthy that 19 of the 35 patients in Group1 used triple antiviral therapy all the time, but their nucleic acid tests were continuous positive; after treated with combined chloroquine phosphate, these patients' nucleic acid tests became negative for SARS-CoV-2 antigens again.In addition, 5 patients who hadn't received any treatment with chloroquine phosphate, were confirmed to have positive nucleic acid testing again even after they were discharged from hospital.So, we speculate that chloroquine phosphate as one antiviral therapy against SARS-CoV-2 infection might be superior to other antiviral treatments [17,18].But due to small sample size of this study, the larger sample size is needed to draw a more accurate conclusion in the near future (Figure 2).

Figure 1 :
Figure 1: Age and clinical classification of the 97 patients with SARS-CoV-2 infection.

Figure 2 :
Figure 2: Chest CT images of one man with SARS-Cov-2 infection.Transverse chest CT images of one man with SARS-CoV-2 infection revealed bilateral ground-glass opacity in both lungs on admission on February 15, 2020.(Fig. 2 A, B).After antiviral therapy, Transverse chest CT images from the patient with SARS-CoV-2 infection showed bilateral ground glass opacity were obviously absorbed on February 21, February 25, and March 1, 2020 (Fig. 2 C, D, E, F, G, H).

Conclusions
COVID-19 patients with longer hospitalization are more severe and need more quadruple antiviral therapy; for patients who don't use chloroquine phosphate, the nucleic acid tests may be more likely to return to positive again even if they have no symptoms at that time.Citation: Zhang Y, Yao H, Zhao L, Hu Y, Zeng X, et al. (2023) Clinical Features of 35 COVID-19 Patients with Hospitalization for More than 20 Days.J Community Med Public Health 7: 373.DOI: https://doi.org/10.29011/2577-2228.100373

Table 1 :
Personal and clinical characteristics of 97 patients with SARS-CoV-2 infection.

Table 3 :
The laboratory findings of 97 patients with SARS-Cov-2 infection (on admission).