Characteristics of sex, age and the days from onset of symptoms to first hospital admission
We did not find a difference in morbidity between men and women, as in previous reports[6-8], which is also different from that in MERS-CoV[9]. However, our result is consistent with 50466 case analyses from the CDC, China[2]. The average age of the patients was approximately 60 years old in both men and women. The variation of the days from onset to first admission was quite large, usually an early onset of symptoms with a delay in hospital admission, which represented the shortage of medical resources during late January and early February. The shortage was relieved very quickly as many referral hospitals were established, and the incidence of disease also decreased. Noticeably, the median time from onset of symptoms to hospital admission was significantly longer for women (Table 1). An analysis of 36 families with cluster-related infection revealed that the time of onset was essentially the same for all patients (data not shown). Members of one family were often admitted to several hospitals. The main reasons for male patients being hospitalized earlier may be that women's resilience to symptoms was higher than in men, and men had more severe disease and more comorbidities[10].
Table 1 The characteristics of sex, age and the days from onset of symptoms to first hospital admission
N
|
Sex
|
Age (S±SD)
|
Days from onset to admission(d±SD)
|
151
|
Male
|
62.4189±12.56061
|
10.4189±5.2112
|
149
|
Female
|
60.87077±11.2789
|
14.1044±5.3645
|
Most of the patients with severe and critical disease were elderly—over 60 years old.
Because patients with mild disease were admitted to the shelter hospital, the patients in this group all had moderate, severe and critical disease based on the guidelines. Similar to previous reports, the patients with severe and critical illness were mainly elderly patients over 60 years old, and there was no difference in the sex distribution of patients (Table 2).The clinical manifestations of COVID-19 in older patients were systemic symptoms and more severe radiological abnormalities (data not shown).
Table 2 Disease severity was directly related to patient age
Age
|
Male(N)
|
Female(N)
|
Moderate
|
Severe
|
Critical
|
Moderate
|
Severe
|
Critical
|
<60
|
29
|
17
|
3
|
43
|
14
|
2
|
≥60,<70
|
35
|
21
|
1
|
24
|
11
|
4
|
≥70
|
42
|
13
|
3
|
21
|
14
|
3
|
|
106
|
51
|
7
|
88
|
39
|
9
|
Early symptoms included fewer upper respiratory symptoms and less sputum
Most patients in this group had been treated in the outpatient department several times, and their symptoms at the time of onset were recorded. As shown in Fig.1, fever, cough and fatigue were the three main symptoms at onset, while the incidence of upper respiratory symptoms (nasal obstruction 1.34%, runny nose 2.34%, and sore throat 7.67%) was lower than the incidence of diarrhea 15.67%. In all 300 cases, more than 71% of the patients had fever, 58.3% of the patients had asthenia, and many patients had chills, but headache, dizziness, muscle pain, chills and other symptoms were rare. The fever type was classified as uncertain, low, medium and high. Most of the patients had dry cough symptoms in the early stage, occasionally accompanied by expectoration. Hemoptysis was rare.
Abnormalities in laboratory data occurred in some non-hypoxemic patients
The laboratory data of the patients at admission, including routine blood examination, CRP, liver and kidney function, coagulation and other indicators, are presented in Table 3. We also found that the lymphocyte count in patients was related to the severity of the disease. A lymphocyte count less than 0.8 × 109/L was more likely to cause critical illness (Fig.2). Moreover, thrombocytopenia, reduced renal function, hypoalbuminemia, elevated D-dimer and elevated CRP, creatine kinase and α-hydroxybutyrate dehydrogenase were also found in COVID-19 patients and were linked to progressive infection (Table 3). It is very interesting to note that there were abnormal myocardial enzyme spectra, liver enzyme spectra and coagulation markers in moderately ill patients who did not have hypoxemia.
Table 3 Laboratory findings on admission
|
ordinary (194)
|
severe (90)
|
critical (16)
|
|
N (%)
|
HB↓
|
52 (26.8)
|
48 (53.33)
|
14 (87.5)
|
WBC↑
|
147 (75.77)
|
70 (77.78)
|
14 (87.5)
|
Lymphocytes account↓
|
85 (43.81)
|
73 (81.11)
|
13 (81.25)
|
Platelet↓
|
24 (12.37)
|
43 (47.78)
|
9 (56.25)
|
CRP↑
|
125 (64.43)
|
82 (91.11)
|
13 (81.25)
|
Procalcitonin↑
|
19 (9.79)
|
20 (22.22)
|
10 (62.5)
|
D-Dimer↑
|
145 (74.74)
|
73 (81.11)
|
16 (100)
|
ALT↑
|
51 (26.29)
|
34 (37.78)
|
3 (18.75)
|
AST↑
|
55 (28.35)
|
40 (44.44)
|
3 (18.75)
|
BSA↓
|
190 (97.94)
|
90 (100)
|
16 (100)
|
BUN↑
|
40 (20.62)
|
27 (30)
|
2 (12.5)
|
creatinine↑
|
34 (17.53)
|
25 (27.78)
|
2 (12.5)
|
lactic acid
|
96 (49.48)
|
43 (47.78)
|
11 (68.75)
|
creatine kinase↑
|
88 (45.36)
|
44 (48.89)
|
12 (75)
|
α-Hydroxybutyrate Dehydrogenase↑
|
105 (54.12)
|
68 (75.56)
|
13 (81.25)
|
Subpleural lesions were typical manifestations on lung CT in the early stage of disease
According to the analysis of the patients’ first lung CT examinations, most were performed within 5 days after onset, and the images were characterized by single or multiple subpleural ground-glass opacities, consolidation, and involvement of less than 50% of the lung. After admission, the lung CT findings showed that most of the patients had reticulation, and a few patients had significantly increased infiltrative shadows, even involving the whole lung (data not shown). Moreover, we observed a relationship between lymphocyte counts and lung CT imaging findings, as shown in Fig.3. The lymphocyte count was negatively correlated with lung injury(R=0.426).