Journal article

View all COVID-19 Respiratory Digests

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Author(s): Chen N, Zhou M, Dong X et al

Lancet 2020; 395: 507–13

Respiratory critical care
Respiratory infections
Epidemiology
General respiratory patient care
Public health
Respiratory intensive care

Digest Author(s): Stylianos Loukides, e-Learning Director / 18 February, 2020

In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. This retrospective study aimed to determine the epidemiological and clinical characteristics of 2019-nCoV pneumonia. 99 confirmed cases were included. Diagnosis was based on clinical and radiological characteristics and clearly confirmed by a real time RT-PCR. For all the cases variables related to epidemiological,laboratory, clinical and radiological characteristics were reported. Short term outcomes were also reported.

From the 99 cases of with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 56 years, predominant males with 100% of detection using real time RT-PCR. 50% of them had co-morbidities. The predominant symptoms were fever, cough while 1/3 of them had dyspnoea. Less reported symptoms were muscle ache, confusion sore throat and headache. The majority of the patients had bilateral opacities. 17% of the patients developed ARDS and among them 11% died of multiple organ failure after a short term worsening period.

Considering and interpreting the above mentioned results we can speculate that older male with co-morbidities were at high risk for developing 2019-nCoV pneumonia.The majority of co-morbidities were cardiovascular and cerebrovascular diseases. Laboratory characteristics showed decreased levels of albumin and increased levels of ESR, CRP, IL-6 and serum ferritin. Interestingly, only a small percentage received systemic corticosteroids. Most of them required oxygen therapy and administration of antivirals & antibiotics. 27% of them received Intravenous immunoglobulin therapy. Finally, no other respiratory viruses were detectable in any of the patients. Acinetobacter baumannii, Klebsiella pneumoniae and Aspergillus flavus were all cultured in one patient with A baumannii to be highly resistant to antibiotics.

On 25th of January 11 patients died, 31 were discharged and 57 remained in the hospital. Analyzing the characteristics of patients who died were in line with the early warning model for predicting mortality in viral pneumonia: the MuLBSTA score. The MuLBSTA score system contains six indexes, which are multilobular infiltration, lymphopenia, bacterial co-infection, smoking history, hypertension, and age.

Comment

There are 4 questions are arising for the clinical physician:

  • Is the number of patients adequate for the results' interpretation?
  • What about the long term outcomes? 60% of patients remained at hospital.
  • Do we have treatment related differences? For example early intervention with intravenous immunoglobin?
  • Is the MulBSTA score applicable to all the infected patients? At the moment the 2019-nCoV pneumonia cases need a more detailed clustering approach in order to predict mortality.