Demographic and clinical characteristics
This study included 68 patients with COVID-19 in Wuhan and 17 patients with COVID-19 in Suining. The demographic and clinical characteristics are provided in Table 1. The median age of patients in Suining was 40.71 years old (interquartile range (IQR 22.03-59.39), and the median age of patients in Wuhan was 56.04 years old (IQR 41.64-70.44). The patients in Wuhan were significantly older than those in Suining. However, there was no significant difference in patient sex between the 2 cities. There were 17 patients in Suining, i.e., 8 males (47.1%) and 9 females (52.9%), and 68 patients in Wuhan, i.e., 35 males (51.5%) and 33 females (48.5%). In terms of epidemiology, the patients in Suining had either traveled or lived in Wuhan before disease onset or had been exposed to patients with confirmed COVID-19 in Suining. The incidence of COVID-19 appeared as family clustering in Suining, as there were 3 families the experienced a clustering of disease onset. In terms of symptoms and signs, fever and cough were the most common symptoms of the 2 groups of patients. There were 9 patients (52.9%) and 8 patients (47.1%) with fever and cough, respectively, in Suining, and 54 patients (79.4%) and 42 patients (61.8%) with fever and cough, respectively, in Wuhan. The incidences of sore throat (4 patients, 23.5%), chills (3 patients, 17.6%) , muscle ache (6 patients, 35.3%) in patients in Suining were higher than those in patients in Wuhan (2 patients (2.9%) with sore throat, 1 patient (1.5%) with chills and 2 patients (2.9%) with muscleache). The patients in Wuhan had othervarious symptoms, including diarrhea (2 patients, 2.9%), headache (2 patients, 2.9%), fatigue (6 patients, 8.8%), hemoptysis (2 patients, 2.9%),inappetence (2 patients, 2.9%), and chest distress(7 patients, 10.3%). Among the patients in Suining, there was 1 patient (5.9%), 2 patients (11.1%) and 5 patients (29.4%) with diarrhea, headache and fatigue, respectively. There was no significant difference between the 2 groups. There was only 1 patient with COVID-19 in Suining who experienced dyspnea (5.9%), but there were 23 patients (33.8%) in Wuhan who experienced dyspnea, a statistically significant difference (P<0.05). There were 2 asymptomatic patients (11.8%) in Suining but none in Wuhan. There was no significant difference in smoking history between the 2 groups of patients. The average incubation period for patients in Suining (10.64 days) was longer than that for patients in Wuhan (7.0 days, P<0.05).
Imaging features
The chest computed tomography (CT) features of patients with COVID-19 were mostly ground-glass opacities, 14 patients (82.4%) in Suining and 40 patients (58.8%) in Wuhan presented these features. Ten patients (58.8%) in Suining presented with patchy shadows in the bilateral lungs, and 31 patients (45.6%) in Wuhan City presented with patchy shadows in the bilateral lungs, there was no significant difference between the 2 groups. Pulmonary consolidation was observed in 2 patients (11.8%) in Suining and 26 patients (38.2%) in Wuhan, the difference was statistically significant (P<0.05). The proportion of patients with COVID-19 with pulmonary nodules was relatively low, with 1 patient (5.9%) and 2 patients (2.9%) in Suining and Wuhan, respectively; there was no significant difference between the 2 groups (Table 1, Figure 1).
Clinical classification
Among the 17 COVID-19 patients in Suining, there were 1 case (5.9%) of mild COVID-19, 14 cases (82.4%) of moderate COVID-19, 1 case (5.9%) of severe COVID-19, and 1 case (5.9%) of critically severe COVID-19. Among the 68 patients in Wuhan, there were no cases of mild COVID-19, 35 cases (51.5%) of moderate COVID-19, 23 cases (33.8%) of severe COVID-19, and 10 cases (14.7%) of critically severe COVID-19. The proportion of patients with moderate COVID-19 in Suining was significantly higher than that of patients with moderate COVID-19 in Wuhan, while the proportion of patients with severe COVID-19 in Wuhan was significantly higher than that of patients with severe COVID-19 in Suining (P<0.05, Table 1).
Comorbidities
There were 6 patients with COVID-19 with hyperlipidemia (35.3%) in Suining but only 2 patients with COVID-19 with hyperlipidemia (2.9%) in Wuhan City; the difference was significantly different (P<0.05). However, 30 of the 68 patients with COVID-19 in Wuhan (44.1%) had hypertension, and 25 patients (36.8%) had diabetes. Three of the 17 patients in Suining (17.6%) had hypertension, and 2 patients (11. 8%) had diabetes. The proportion of patients with COVID-19 with diabetes or hypertension in Wuhanwas significantly higher than that of patients with COVID-19 with diabetes or hypertension in Suining (P<0.05). Among the patients in Suining, 1 patient (5.9%) had rheumatic heart disease, and 2 patients (11.8%) were hepatitis B virus (HBV) carriers. The comorbidities in patients with COVID-19 in Wuhan also included rheumatoid arthritis (1 patient, 1.5%), gastric ulcer (1 patient, 1.5%), chronic hepatitis B (2 patients, 2.9%), coronary atherosclerotic heart disease (2 patients, 2.9%), chronic nephritis (2 patients, 2.9%), anemia (1 patient, 1.5%), cerebral infarction (2 patients, 2.9%), Alzheimer's disease (1 patient, 1.5%), hypothyroidism (1 patient, 1.5%), and chronic renal insufficiency (2 patients, 2.9%).
Treatments and prognosis
Antiviral therapy and antibiotics were commonly used in COVID-19 treatments. 16 patients in Suining (94.1%) received antiviral therapy or antibiotics, respectively, and 66 patients (97.1%) and 54 patients (79.4%) in Wuhan received antiviral therapy or antibiotics, respectively. There was no significant difference between the 2 groups. In terms of other treatment, in Suining, 1 patient (5.9%) received antifungals, 2 patients (11.8%) received steroids, 17 patients (100%) received traditional Chinese medicine, 5 patients (29.4%) received thymosin, and 3 patients (17.6%) received immunoglobulin supportive treatments. In Wuhan, 3 patients (4.4%), 14 patients (20.6%), 9 patients (13.2%), 12 patients (17.6%), and 30 patients (44.1%) received antifungal, steroids, traditional Chinese medicine, thymosin, and immunoglobulin supportive treatments, respectively. More patients in Wuhan than in Suining received immunoglobulin supportive treatments, and more patients in Suining than in Wuhan were treated with Chinese medicine (P<0.05). One patient (5.9%) in Suining received plasma exchange therapy, and 1 patient (1.5%) in Wuhan received hemodialysis. Two patients (11.8%) in Suining received mechanical ventilation, and 27 patients (39.7%) in Wuhan received mechanical ventilation, the difference was statistically significant (P<0.05). The average length from symptom onset to hospital visit was approximately 8.44 days(IQR, 1.67 to 15.21) in Wuhan and 4.47days(IQR, 0.04 to 8.9) in Suinning, the time of hospital visit of patients in Wuhan was longer than that in Suining.The average length of hospital stay of patients in Suining was 12.29 days (IQR, 8.92 to 15.66), significantly shorter than that of patients in Wuhan (17.49 days, IQR, 6.59 to 28.39) (P<0.05). As of February 27, 2020, 2 patients (11.8%) were still hospitalized in Suining, and 19 patients (27.9%) were still hospitalized in Wuhan. Fifteen patients (88.2%) were discharged in Suining, and 43 patients (63.2%) were discharged in Wuhan. Of the patients in Wuhan, 6 died (8.8%); no deaths were reported in Suining (Table 1).
Table 1
Demographics, clinical characteristics of patients with 2019-nCoV in Suining and Wuhan.
|
|
Patients in Suining(n=17)
|
|
|
Patients in Wuhan(n=68)
|
P
|
|
|
Age(y)
|
|
40.71±18.68
|
|
|
56.04±14.40
|
<0.01
|
|
|
Sex No., %
|
|
|
|
|
|
|
|
|
Male
|
|
8(47.1%)
|
|
|
35(51.5%)
|
0.745
|
|
|
Female
|
|
9(52.9%)
|
|
|
33(48.5%)
|
0.745
|
|
|
Signs and symptoms on
admission No., %
|
|
|
|
|
|
|
|
|
Fever
|
|
9(52.9%)
|
|
|
54(79.4%)
|
0.055
|
|
|
Cough
|
|
8(47.1%)
|
|
|
42(61.8%)
|
0.270
|
|
|
Dyspnea
|
|
1(5.9%)
|
|
|
23(33.8%)
|
0.047
|
|
|
Diarrhea
|
|
1(5.9%)
|
|
|
2(2.9%)
|
0.493
|
|
|
Muscle ache
|
|
6(35.3%)
|
|
|
2(2.9%)
|
<0.001
|
|
|
Headache
|
|
2(11.1%)
|
|
|
2(2.9%)
|
0.177
|
|
|
Sore throat
|
|
4(23.5%)
|
|
|
2(2.9%)
|
0.015
|
|
|
Chill
|
|
3(17.6%)
|
|
|
1(1.5%)
|
0.02
|
|
|
Fatigue
|
|
5(29.4%)
|
|
|
6(8.8%)
|
0.063
|
|
|
Hemoptysis
|
|
0(0%)
|
|
|
2(2.9%)
|
1.00
|
|
|
Inappetence
|
|
0(0%)
|
|
)
|
2(2.9%)
|
1.00
|
|
|
Chest distress
|
|
0(0%)
|
|
|
7(10.3%)
|
0.375
|
|
|
No symptoms
|
|
2(11.8%)
|
|
|
0(0%)
|
0.038
|
|
|
Smoking history No., %
|
|
|
|
|
|
|
|
|
Never smokers
|
|
15(88.2%)
|
|
|
60(88.2%)
|
1
|
|
|
Current smokers and Ex-smokers
|
|
2(11.8%)
|
|
|
8(11.8%)
|
1
|
|
|
History of epidemiology No., %
|
|
|
|
|
|
|
|
|
Local residents of Wuhan
|
|
0(0%)
|
|
|
68(100%)
|
<0.001
|
|
|
Recently been to Wuhan or Contacted with people from Wuhan
|
|
17(100%)
|
|
|
0(0%)
|
<0.001
|
|
|
Incubation period(days)
|
|
10.64±10.40
|
|
|
7.0±3.79
|
0.021
|
|
|
Chest CT findings
No., %
|
|
|
|
|
|
|
|
|
Ground-glass opacity
|
|
14(82.4%)
|
|
|
40(58.8%)
|
0.071
|
|
|
patchy shadows
|
|
10(58.8%)
|
|
|
31(45.6%)
|
0.329
|
|
|
Pulmonary consolidation
|
|
2(11.8%)
|
|
|
26(38.2%)
|
0.038
|
|
|
Pulmonary nodule
|
|
1(5.9%)
|
|
|
2(2.9%)
|
0.493
|
|
|
Clinical classification No., %
|
|
|
|
|
|
|
|
|
Mild type
|
|
1(5.9%)
|
|
|
0(0%)
|
0.2
|
|
|
Moderate type
|
|
14(82.4%)
|
|
|
35(51.5%)
|
0.021
|
|
|
Severe type
|
|
1(5.9%)
|
|
|
23(33.8%)
|
0.047
|
|
|
Critically type
|
|
1(5.9%)
|
|
|
10(14.7%)
|
0.572
|
|
|
Comorbidities No., %
|
|
|
|
|
|
|
|
|
hypertension
|
|
3(17.6%)
|
|
|
30(44.1%)
|
0.045
|
|
|
diabetes mellitus
|
|
2(11.8%)
|
|
|
25(36.8%)
|
0.048
|
|
|
hyperlipidemia
|
|
6(35.3%)
|
|
|
2(2.9%)
|
<0.001
|
|
|
heumatic heart disease
|
|
1(5.9%)
|
|
|
0
|
0.200
|
|
|
hepatitis B virus carrier
|
|
2(11.8%)
|
|
|
0
|
0.03
|
|
|
rheumatoid arthritis
|
|
0
|
|
|
1(1.5%)
|
1
|
|
|
Gastric ulcer
|
|
0
|
|
|
1(1.5%)
|
1
|
|
|
chronic viral hepatitis B
|
|
0
|
|
|
2(2.9%)
|
1
|
|
|
coronary heart disease
|
|
0
|
|
|
2(2.9%)
|
1
|
|
|
chronic nephritis
|
|
0
|
|
|
2(2.9%)
|
1
|
|
|
anemia
|
|
0
|
|
|
1(1.5%)
|
1
|
|
|
cerebral infarction
|
|
0
|
|
|
2(2.9%)
|
1
|
|
|
Alzheimer's disease
|
|
0
|
|
|
1(1.5%)
|
1
|
|
|
hypothyroidism
|
|
0
|
|
|
1(1.5%)
|
1
|
|
|
chronic renal insufficiency
|
|
0
|
|
|
2(2.9%)
|
1
|
|
|
Treatment No., %
|
|
|
|
|
|
|
|
|
Antiviral treatment
|
|
16(94.1%)
|
|
|
66(97.1%)
|
0.493
|
|
|
Antibiotic treatment
|
|
16(94.1%)
|
|
|
54 (79.4%)
|
0.286
|
|
|
Antifungal medications
|
|
1(5.9%)
|
|
|
3(4.4%)
|
1
|
|
|
steroidstherapy
|
|
2(11.8%)
|
|
|
14(20.6%)
|
0.627
|
|
|
Mechanical ventilation
|
|
2(11.8%)
|
|
|
27(39.7%)
|
0.03
|
|
|
Traditional Chinese medicine
|
|
17(100%)
|
|
|
9(13.2%)
|
<0.001
|
|
|
Plasma exchange
|
|
1(5.9%)
|
|
|
0
|
0.200
|
|
|
Use of thymosin
|
|
5(29.4%)
|
|
|
12(17.6%)
|
0.456
|
|
|
Use of intravenous immunoglobin
|
|
3(17.6%)
|
|
|
30(44.1%)
|
0.045
|
|
|
Use of hemodialysis
|
|
0
|
|
|
1(1.5%)
|
1
|
|
|
Time of hospital visit (days)
|
|
4.47±4.43
|
|
|
8.44±6.77
|
0.024
|
|
|
Hospital stay(days)
|
|
12.29±3.37
|
|
|
17.49±10.9
|
0.048
|
|
|
Clinical outcomes No., %
|
|
|
|
|
|
|
|
|
Death
|
|
0
|
|
|
6(8.8%)
|
0.459
|
|
|
Remained in hospital
|
|
2(11.8%)
|
|
|
19(27.9%)
|
0.285
|
|
|
Discharge from hospital
|
|
15(88.2%)
|
|
|
43(63.2%)
|
0.048
|
|
|
|
|
|
|
|
|
|
|
|
|
COVID-19, coronavirus disease 2019, time of hospital visit, the time from symptom onset to hospital visit, p values denoted the comparison between Suining group and Wuhan group. |
Laboratory tests
Laboratory tests showed elevated white blood cell (WBC) counts in 1 patient (5.9%) in Suining and in 20 of 68 patients (29.4%) in Wuhan and reduced WBC counts in 2 patients (11.8%) in Suining and 2 of 68 patients (2.9%) in Wuhan (Table 2),there were no significant differences between the 2 cities. Among the 17 patients with COVID-19 in Suining, 6 (35.3%) had a lower lymphocyte count than normal, while 43 patients (63.2%) in Wuhan had a decreased lymphocyte count, with significant difference between the 2 groups. However, the percentage of patients with increased neutrophils in Suining (4 cases, 23.5%) was significantly lower than that in Wuhan (36 cases, 52.9%), (P<0.05). Platelet counts were elevated in 6 patients (8.8%) in Wuhan and reduced in 11 patients (16.2%) in Wuhan and reduced in 3 (17.6%) patients in Suining. Hemoglobin levelswere decreasedin 36 patients (52.9%) in Wuhan and in 7 patients (41.2%) in Suining. There were no significant differences in platelet counts and hemoglobin levels between the 2 groups of patients. 5 patients (29.4%) in Suining had CRP levels greater than 10 mg/L, and 40 patients (58.8%) in Wuhan had elevated CRP levels, the percentage of patients with CRP increased in Wuhan were significantly higher than that in Suining(P<0.05).
Among the 17 patients in Suining, 3 patients (17.6%) had elevated aspartate aminotransferase (AST) levels, 7 patients (41.2%) had decreased albumin levels, 1 patient (5.9%) had an increased total bilirubin level, 7 patients (41.2%) with elevated lactate dehydrogenase (LDH) levels, and 8 patients (47.1%) had elevated procalcitonin levels. Among the 68 patients in Wuhan, 11 patients (16.2%) had elevated AST levels, 26 patients (38.2%) had reduced albumin levels, 3 patients (4.4%) had decreased blood glucose levels, 5 patients (7.4%) had elevated blood urea nitrogen levels, 9 patients (13.2%) had elevated creatinine levels, 37 patients (53.6%) had elevated LDH levels, 9 patients (13.2%) had elevated myoglobin levels, and 33 patients (48.5%) had elevated procalcitonin levels. There were no significant differences between the 2 groups. However, in Suining, 1 patient (5.9%) had elevated alanine aminotransferase (ALT) levels, 3 patients (17.6%) had elevated blood glucose levels, and 1 patient (5.9%) had increased creatine kinase (CK) levels. Among the patients in Wuhan, 23 patients (33.8%) had elevated ALT levels, 31 cases (45.6%) had elevated blood glucose levels, and 23 patients (33.8%) had elevated CK levels. The proportion of patients with elevated ALT, blood glucose and CK in Suining was significantly lower in Wuhan (P<0.05) (Table 2).
In Suining, there were 8 patients (47.1%) with prolonged activated partial thromboplastin time (APTT) and 1 patient (5.9%) with prolonged prothrombin time (PT), and in Wuhan, there were 30 patients (44.1%) with prolonged APTT and 17 patients (25.0%) with prolonged PT; there was no difference between the 2 groups. However, 3 patients (17.6%) in Suining had elevated plasma D-dimer levels, and 32 patients (47.1%) in Wuhan City had elevated D-dimer levels. The percentage of patients with elevated D-dimer levels in Wuhan was significantly higher than in Suining (P<0.05) ( Table 2).
Table 2
Laboratory findings of 86 patients with 2019-nCoV in Suining and Wuhan
|
Patients in Suining(n=17)
|
Patients in Wuhan(n=68)
|
P
|
Blood routine No.No. (%)
|
|
Normal rang
|
|
|
Normal rang
|
|
|
leukocyte count(×109/L)
|
|
3.5-9.5
|
|
|
3.7-10
|
|
|
|
increased
|
|
1(5.9%)
|
|
|
20(29.4%)
|
0.09
|
|
decreased
|
|
2(11.8%)
|
|
|
2(2.9%)
|
1.000
|
Lymphocyte count(×109/L)
|
|
1.1-3.2
|
|
|
0.8-4.0
|
|
|
|
decreased
|
|
6(35.3%)
|
|
|
43(63.2%)
|
0.037
|
Neutrophil count(%)
|
|
40-75
|
|
|
43-77
|
|
|
|
increased
|
|
4(23.5%)
|
|
|
36(52.9%)
|
0.03
|
Platelet count(×109/L)
|
|
125-350
|
|
|
85-320
|
|
|
|
increased
|
|
0
|
|
|
6(8.8%)
|
0.459
|
|
decreased
|
|
3(17.6%)
|
|
|
11(16.2%)
|
1.000
|
Haemoglobin (g/L)
|
|
130-175
|
|
|
110-172
|
|
|
|
decreased
|
|
7(41.2%)
|
|
|
36(52.9%)
|
0.386
|
C-reactive protein level≥10 mg/L No.No. (%)
|
|
|
5(29.4%)
|
|
|
40(58.8%)
|
0.03
|
Blood biochemistry No.No. (%)
|
|
Normal rang
|
|
|
|
|
|
Alanine aminotransferase(U/L)
|
|
9-50
|
|
|
0-40
|
|
|
|
increased
|
|
1(5.9%)
|
|
|
23(33.8%)
|
0.022
|
Aspartate aminotransferase(U/L)
|
|
15-40
|
|
|
0-45
|
|
|
|
increased
|
|
3(17.6%)
|
|
|
11(16.2%)
|
1.000
|
Albumin(g/L)
|
|
40-55
|
|
|
35-55
|
|
|
|
decreased
|
|
7(41.2%)
|
|
|
26(38.2%)
|
1.000
|
Total bilirubin(μmol/L)
|
|
5.1-28
|
|
|
2-25
|
|
|
|
increased
|
|
1(5.9%)
|
|
|
6(8.8%)
|
1.000
|
Glucose(mmol/L)
|
|
3.89-6.11
|
|
|
3.6-6.11
|
|
|
|
increased
|
|
3(17.6%)
|
|
|
31(45.6%)
|
0.035
|
|
decreased
|
|
0
|
|
|
3(4.4%)
|
1.000
|
Blood urea nitrogen(mmol/L)
|
|
2.86-8.2
|
|
|
3.1-8
|
|
|
|
increased
|
|
0
|
|
|
5(7.4%)
|
0.564
|
Serum creatinine(μmol/L)
|
|
57-111
|
|
|
57-97
|
|
|
|
increased
|
|
0
|
|
|
9(13.2%)
|
0.252
|
Creatine kinase (U/L)
|
|
50-310
|
|
|
24-195
|
|
|
|
increased
|
|
1(5.9%)
|
|
|
23(33.8%)
|
0.047
|
Lactate dehydrogenase(U/L) No.No. (%)
|
|
120-250
|
|
|
90-250
|
|
|
|
increased
|
|
7(41.2%)
|
|
|
37(53.6%)
|
0.358
|
Myoglobin(ng/ml) No.No. (%)
|
|
0-154.9
|
|
|
0-90000
|
|
|
|
increased
|
|
0
|
|
|
9(13.2%)
|
0.252
|
Procalcitonin level ≥0.5 ng/ml –No.No. (%)
|
|
|
8(47.1%)
|
|
|
33(48.5%)
|
0.914
|
Coagulation function No.No. (%)
|
|
Normal rang
|
|
|
|
|
|
Activated partial thromboplastin time (s)
|
|
26-40
|
|
|
20-40
|
|
|
|
increased
|
|
8(47.1%)
|
|
|
30(44.1%)
|
0.827
|
Prothrombin time (s)
|
|
11-14.5
|
|
|
9-13
|
|
|
|
increased
|
|
1(5.9%)
|
|
|
17(25.0%)
|
0.163
|
D-dimer(μg/L)
No.No. (%)
|
|
0-0.5
|
|
|
0-0.55
|
|
|
|
increased
|
|
3(17.6%)
|
|
|
32(47.1%)
|
0.028
|
COVID-19, coronavirus disease 2019; p values denoted the comparison between Suining group and Wuhan group. |