COVID-19 pneumonia patients in Wuhan, China [Classics Series]

This study summary is an excerpt from the book 2 Minute Medicine’s The Classics in Medicine: Summaries of the Landmark Trials

1. This case series of patients with novel coronavirus–infected pneumonia (NCIP) found that 32% were admitted to the intensive care unit (ICU) and 15% died.

2. A significant proportion of patients (29%) developed acute respiratory distress syndrome

Original Date of Publication: January 2020

Study Rundown: In this prospective case series, clinical features of NCIP patients in Wuhan, China were investigated during the beginning of the pandemic. The majority of patients were men without underlying chronic disease who had been exposed at the Huanan seafood market. The most common symptoms on initial presentation were fever, cough, myalgia, and fatigue. After admission, over half of patients developed lymphopenia and dyspnea. The present study was limited in that it evaluated a limited cohort of hospitalized patients. Thus, the findings cannot be extrapolated to the general population of COVID-19 patients. Additionally, only lower respiratory tract specimens were obtained to confirm diagnosis without information on viral load. In summary, COVID-19 infection may result in NCIP, severe respiratory distress, and subsequent ICU admission.

Click to read the study in The Lancet

In-Depth [prospective case-series]: This prospective case series evaluated the clinical presentation and course of NCIP inpatients (n = 41). Almost three quarters of participants were male (73%) with a median age of 49. Only 32% of patients had underlying chronic disease, the most common being diabetes (20%). The most common presenting complaints were fever (98%) and cough (76%). Dyspnea occurred in 55% of patients at a median time of 8 days after initial symptoms. Acute respiratory distress syndrome occurred in 29% of patients with 15% of patients being admitted to the ICU and a 15% mortality rate. During initial evaluation, significantly increased prothrombin time (p = 0.012) and D-dimer levels (p = 0.0042) were seen in patients who were admitted to the ICU. Most patients were treated with antiviral therapy (93%), and all patients initially received empirical antibiotic treatment. Additionally, 22% of patients received systemic corticosteroids.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020 Feb 15;395(10223):497-506.

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