Demographics and clinical characteristics
By 22 Feb 2020, 113 patients with SARS-CoV-2 infection were included in the study, including 36 (31.9%) patients without fever and 77 (68.1%) patients with fever on admission. In total, 75 (64%) patients had a history of Hubei exposure and all 113 patients had been exposed to people infected by SARS-CoV-2. There was no difference in the history of Hubei exposure between without fever and fever patients. Of these patients, the median age was 45 years (IQR, 35–60; Range, 8-83years) and 62 (54.9%) were male (Table 1). Compared with fever patients, the patients without fever were younger (median, 41vs 50 years) and were more likely to admission early (median, 3 vs 5 days, P = 0.032). The underlying comorbidities between patients without fever and fever patients were significant differences. Only 5 (13.9%) patients without fever had the underlying disease, less than those in fever patients (26[33.8%], P = 0.027). Hypertension (17[15.0%]), diabetes (6[5.2%]), cardiovascular disease (3[2.7%]) were the most common underlying diseases.
Table 1
Clinical characteristics of 113 patients infected by SARS-CoV-2
|
All patients(n = 113)
|
Non-fever(n = 36)
|
Fever(n = 77)
|
P-value
|
Characteristics
|
|
|
|
|
Age, years, IQR
|
45 (35.0, 60.0)
|
41 (30.0, 53.5)
|
50 (37.0,6 4.0)
|
0.104
|
< 18
|
7 (6.2%)
|
4 (11.1%)
|
3 (3.9%)
|
0.253
|
18–40
|
33 (29.2%)
|
13 (36.1%)
|
20 (26.0%)
|
|
40–65
|
53 (46.9%)
|
14 (38.9%)
|
39 (50.7%)
|
|
≥ 65
|
20 (17.7%)
|
5 (13.9%)
|
15 (19.5%)
|
|
Gender
|
|
|
|
0.477
|
Male
|
62 (54.9%)
|
18 (50.0%)
|
44 (57.1%)
|
|
Female
|
51 (45.1%)
|
18 (50.0%)
|
33 (42.9%)
|
|
Hubei exposure
|
75 (66.4%)
|
23 (63.9%)
|
52 (67.5%)
|
0.702
|
Current smoking
|
11 (9.7%)
|
3 (8.3%)
|
8 (10.4%)
|
0.731
|
Drinking
|
2 (1.8%)
|
0 (0.0%)
|
2 (2.6%)
|
0.329
|
Any comorbidity
|
31(27.4%)
|
5(13.9%)
|
26(33.8%)
|
0.027
|
Hypertension
|
17 (15.0%)
|
3 (8.3%)
|
14 (18.2%)
|
0.172
|
Cardiovascular disease
|
3 (2.7%)
|
0 (0.0%)
|
3 (3.9%)
|
0.230
|
Diabetes
|
6 (5.3%)
|
2 (5.6%)
|
4 (5.2%)
|
0.936
|
Cerebrovascular disease
|
1 (0.9%)
|
0 (0.0%)
|
1 (1.3%)
|
0.492
|
Chronic obstructive pulmonary disease
|
1 (0.9%)
|
0 (0.0%)
|
1 (1.3%)
|
0.498
|
Chronic liver disease
|
2 (1.8%)
|
0 (0.0%)
|
2 (2.6%)
|
0.329
|
Malignant tumor
|
1 (0.9%)
|
0 (0.0%)
|
1 (1.3%)
|
0.498
|
Signs and symptoms
|
|
|
|
|
Cough
|
61 (5.0%)
|
13 (36.1%)
|
48 (62.3%)
|
0.009
|
Fatigue
|
37 (32.7%)
|
5 (13.9%)
|
32 (41.6%)
|
0.003
|
Myalgia
|
11 (9.7%)
|
3 (8.3%)
|
8 (10.4%)
|
0.731
|
Expectoration
|
33 (29.2%)
|
13 (36.1%)
|
20 (26.0%)
|
0.270
|
Anorexia
|
3 (2.7%)
|
1 (2.8%)
|
2 (2.6%)
|
0.956
|
Headache
|
7 (6.2%)
|
0 (0.0%)
|
7 (9.1%)
|
0.062
|
Dyspnea
|
13 (11.5%)
|
2 (5.6%)
|
11 (14.3%)
|
0.175
|
Diarrhea
|
3 (2.7%)
|
0 (0.0%)
|
3 (3.9%)
|
0.230
|
Sore throat
|
12 (10.6%)
|
7 (19.4%)
|
5 (6.5%)
|
0.037
|
Nausea
|
1 (0.9%)
|
0 (0.0%)
|
1 (1.3%)
|
0.492
|
Dizziness
|
2 (1.8%)
|
0 (0.0%)
|
2 (2.6%)
|
0.329
|
Days from illness onset to first hospital admission (days), IQR
|
4 (3.0, 7.0)
|
3 (2.0, 5.0)
|
5 (3.0, 7.0)
|
0.032
|
Systolic pressure, mmHg, Mean (SD)
|
124.9 ± 12.9
|
125.7 ± 15.0
|
124.5 ± 11.9
|
0.640
|
Diastolic pressure, mmHg, Mean (SD)
|
78.8 ± 9.2
|
80.0 ± 9.6
|
78.3 ± 9.0
|
0.359
|
Respiratory rate > 24 breaths per min
|
3 (2.9%)
|
0 (0.0%)
|
3 (4.0%)
|
0.227
|
Heart rate > 100 beats per min
|
30 (26.6%)
|
5 (13.9%)
|
25 (32.5%)
|
0.037
|
Data are n (%) unless specified otherwise. IQR, interquartile range. |
Among the patients without fever, the most common symptoms at onset were cough (13[36.1%]), expectoration (13[36.1%]), sore throat (7[19.4%]), and fatigue (5[13.9%]). Among patients in the fever group, followed by cough (48[62.3%]), fatigue (32[41.6%]), and expectoration (20[26%]). The symptom of sore throat in patients without fever were more in frequency than the fever group (P = 0.037).
Laboratory testing and vital signs
On admission, there were more cases in fever patients of fast heart rate (> 100 bpm) when compared with this in patients without fever (32% vs 13.9, P = 0.037). There was no difference between fever and patients without fever on respiratory rate, systolic pressure and diastolic pressure (Table 1). Of all patients’ admission recordings, 37.2% and 10.6% of patients had leucopenia and thrombocytopenia, respectively. Moreover, the levels of white blood cell count, lymphocyte count, monocyte count, and platelet count in patients without fever were higher than fever patients (P < 0.05). However, the levels of lactate dehydrogenase, C-reactive protein, and erythrocyte sedimentation rate in patients without fever were lower than those in patients with fever (P < 0.05) (Table 2). All of the 36 patients without fever had received the chest CT scan, 5 (13.9%) of them showed unilateral pneumonia, 29 (80.6%) of them showed Bilateral pneumonia (Fig. 1).
Table 2
Laboratory and chest radiography findings in patients infected by SARS-CoV-2
|
All patients(n = 113)
|
Non-fever(n = 36)
|
Fever(n = 77)
|
P-value
|
White blood cell count, × 10⁹/L, IQR
|
4.6 (3.5, 5.7)
|
5.4 (4.4, 6.2)
|
4.1 (3.4, 5.4)
|
0.012
|
Neutrophil count, × 10⁹/L, IQR
|
2.9 (2.2, 3.5)
|
3.0 (2.3, 3.7)
|
2.9 (2.2, 3.4)
|
0.802
|
Lymphocyte count, × 10⁹/L, IQR
|
1.2 (0.8, 1.7)
|
1.70 (1.2, 2.4)
|
1 (0.7, 1.4)
|
< 0.001
|
Hemoglobin, g/L, IQR
|
131(121.0, 144.0)
|
130.5(123.5, 141.3)
|
131 (121.0, 145.0)
|
0.753
|
Monocyte count, × 10⁹/L, IQR
|
0.4 (0.3, 0.4)
|
0.4(0.3, 0.5)
|
0.3 (0.2, 0.4)
|
0.009
|
Platelet count, × 10⁹/L, IQR
|
163(139.0, 228.0)
|
216(169.5, 268.3)
|
158 (131.0, 184.0)
|
0.032
|
Prothrombin time, s, IQR
|
12 (11.1, 12.5)
|
11.6 (11.1, 12.3)
|
12(11.1, 12.5)
|
0.087
|
Activated partial thromboplastin time, s, IQR
|
32.8 (30.3, 35.0)
|
31.8 (30.1, 35.7)
|
32.9 (30.6, 34.9)
|
0.520
|
D-dimer, ug/mL, IQR
|
0.2 (0.1, 0.4)
|
0.2(0.1, 0.4)
|
0.2 (0.1, 0.4)
|
0.728
|
Albumin, g/L, IQR
|
38.3(35.5, 41.5)
|
41 (38.8, 43.1)
|
37 (34.7, 39.1)
|
0.854
|
Alanine aminotransferase, U/L, IQR
|
20(14.61, 27.80)
|
15.7 (11.81, 25.25)
|
21.8 (17.0, 29.0)
|
0.014
|
Aspartate aminotransferase, U/L, IQR
|
25 (20.0, 33.0)
|
24.4 (17.1, 28.0)
|
26 (21.0, 33.0)
|
0.067
|
Total bilirubin, mmol/L, IQR
|
11 (8.6, 15.4)
|
10 (7.2, 14.4)
|
11.3 (9.2, 15.4)
|
0.337
|
Direct bilirubin, mmol/L, IQR
|
4 (2.8, 5.5)
|
3.5 (2.4, 5.0)
|
4 (3.1, 5.6)
|
0.224
|
Creatinine, µmol/L, IQR
|
53 (40.7, 66.1)
|
51.5(41.8, 65.9)
|
54 (40.7, 67.0)
|
0.690
|
Lactate dehydrogenase, U/L, IQR
|
172(145.0, 208.0)
|
151 (124.8,176.3)
|
184.3 (150.0,235.0)
|
0.001
|
Creatine kinase, U/L, IQR
|
76(52.0, 113.0)
|
73.5 (45.7, 87.2)
|
76 (53.0, 124.0)
|
0.086
|
C-reactive protein, mg/L, Mean (SD)
|
13.2 (4.2, 35.0)
|
4 (1.1, 13.0)
|
19.8(8.6, 39.)
|
< 0.001
|
Procalcitonin, ng/mL, IQR
|
0.05 (0.05, 0.05)
|
0.05 (0.05, 0.05)
|
0.05 (0.05, 0.05)
|
0.862
|
Erythrocyte sedimentation rate, mm/h, IQR
|
42(16.0, 70.0)
|
23 (11.0, 59.50)
|
48 (27.0, 72.0)
|
0.014
|
Unilateral pneumonia
|
11 (9.7%)
|
5 (13.9%)
|
6 (7.8%)
|
0.518
|
Bilateral pneumonia
|
93 (82.3%)
|
29 (80.6%)
|
64 (83.1%)
|
|
Data are n (%) unless specified otherwise. IQR, interquartile range. |
Complications and treatment
During hospitalization, 14 (12.4%) of patients developed into ARDS and one (0.9%) patients developed into AKI. None of the patients without fever developed into ARDS or AKI compared with fever patients (0% vs 18.2%, P = 0.006) (Table 3). For the patients without fever, all of them received the oxygen support of the nasal cannula. In 14 fever patients with ARDS, 10 of them received high flow high-flow nasal cannula oxygen, and 3 of them received invasive ventilation (1patient was given extracorporeal membrane oxygenation). Most of the cases were given antiviral treatment and traditional Chinese medicine treatment in both patients without fever and fever patients. 12 (33.4%) patients without fever received antibiotic treatment which was less than 51(66.2%) of fever patients (P = 0.001). Additionally, systematic corticosteroid and gamma globulin treatment were less used in patients without fever compared with fever patients (P < 0.001).
Table 3
Treatments and outcomes in patients infected by SARS-CoV-2
|
All patients(n = 113)
|
Non-fever(n = 36)
|
Fever(n = 77)
|
P-value
|
Complications
|
|
|
|
|
Acute respiratory distress syndrome
|
14 (12.4%)
|
0 (0.0%)
|
14 (18.2%)
|
0.006
|
Acute kidney injury
|
1 (0.9%)
|
0 (0.0%)
|
1 (1.3%)
|
0.492
|
Treatment
|
|
|
|
|
Antiviral therapy
|
104 (92.0%)
|
32 (89.0%)
|
72 (93.5%)
|
0.398
|
Antibiotic therapy
|
63 (55.8%)
|
12 (33.4%)
|
51 (66.2%)
|
0.001
|
Use of corticosteroid
|
42 (37.2%)
|
3 (8.3%)
|
39 (50.7%)
|
< 0.001
|
Gamma globulin
|
38 (33.6%)
|
3 (8.3%)
|
35 (45.5%)
|
< 0.001
|
Continuous renal replacement therapy
|
1 (0.9%)
|
0 (0.0%)
|
1 (1.3%)
|
0.492
|
Traditional Chinese medicine treatment
|
109 (96.5%)
|
36 (100.0%)
|
73 (94.8%)
|
0.164
|
Oxygen support
|
|
|
|
|
Nasal cannula
|
100 (88.5%)
|
36 (100.0%)
|
64 (83.1%)
|
0.009
|
High-flow nasal cannula
|
10 (8.9%)
|
0 (0.0%)
|
10 (13.0%)
|
0.024
|
Non-invasive ventilation
|
1 (0.9%)
|
0 (0.0%)
|
1 (1.3%)
|
0.492
|
Invasive mechanical ventilation
|
2 (1.8%)
|
0 (0.0%)
|
2 (2.6%)
|
0.329
|
Invasive mechanical ventilation and ECMO
|
1 (0.9%)
|
0 (0.0%)
|
1 (1.3%)
|
0.492
|
Prognosis
|
|
|
|
0.834
|
Hospitalization
|
83 (73.5%)
|
28 (77.8%)
|
55 (71.4%)
|
|
Discharge
|
28 (24.8%)
|
8 (22.2%)
|
20 (26.0%)
|
|
Death
|
2 (1.8%)
|
0 (0.0%)
|
2 (2.6%)
|
|
Data are n (%) unless specified otherwise. ECMO, extracorporeal membrane oxygenation. |
Outcomes
As of Feb 22, 2020, 28 patients have been discharged and two patients died (1.8%). A total of 83 patients are still hospitalized. Although two of the fever patients were dead, the prognosis between without fever and fever patients had no difference follow up to Feb 22, 2020. Discharge health is based on fever reduction for at least three days, and there is better evidence that chest X-rays and the virus clear samples from the lower respiratory tract.