Clinical progression of patients with COVID-19 in Shanghai, China

Abstract

Background: Studies on the 2019 novel coronavirus disease (COVID-19) have generally been limited to the description of the epidemiology and initial clinical characteristics. We investigated the temporal progression in patients with COVID-19.

Methods: In this retrospective, single-center study, we included confirmed cases of COVID-19 from Jan 20 to Feb 6, 2020 in Shanghai. Final date of follow-up was February 25, 2020.

Results: Of the 249 patients enrolled, the median age was 51 years old, and 126 (50.6%) were male. The duration from onset of symptoms to hospitalization was 4(2-7) days in symptomatic patients. Fever was occurred in 235(94.3%) patients. A total of 215 (86.3%) patients had been discharged after 16(12-20) days hospitalization. The estimated median duration of fever in all the patients with fever was 10 days (95 confidential intervals [CIs]: 8-11 days) after onset of symptoms. Patients who were transferred to intensive care units (ICU) had significantly longer duration of fever as compared to those not in ICU (31 days v.s. 9 days after onset of symptoms, respectively, P <0.0001). Radiological aggravation of initial image was observed in 163 (65.7%) patients on day 7 after onset of symptoms. 154(94.5%) of these patients showed radiological improvement on day 14. The median duration to negative reverse-transcriptase PCR tests of upper respiratory tract samples was 11 days (95 CIs: 10-12 days). Viral clearance was more likely to be delayed in patients in ICU than those not in ICU (P <0.0001). In multivariate logistical analysis, age (Odds ratio [OR] = 1.06) and CD4 T cell count (OR = 0.55 per 100 cells/ul increase) were independently associated with ICU admission.

Conclusions: The majority of COVID-19 cases are mild. The clinical progression pattern suggests that early control of viral replication and application of host-directed therapy in later stage is essential to improve the prognosis of CVOID-19.

Keywords: COVID-19; Clinical characteristics; Clinical progression; SARS-CoV-2; Viral clearance.

Fig. 1

Duration of fever in patients in ICU and not in ICU from onset of symptoms. ICU: intensive care units.

Fig. 2

Computed tomographic (CT) scans of two patients. Case 1: Chest CT scans on admission of a 75 years old female on day 3 after onset of symptoms (A). CT scan showed worsening on day 6 manifested by bilateral multiple ground-glass opacities (B); Chest CT scan on day 9 showed improved status (C). Case 2: Chest CT scans on admission of a 30 years old on day 5 after onset of symptoms (D). Improvement of original lesions together with the appearance of new lesions on day 10 (E). Chest CT scan on day 13 showed worsening status (F).

Fig. 3

Time to a negative conversion of virus by PCR analysis of upper respiratory tract samples.