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Клинические симптомы инфекции коронавирусом 2019-nCov

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia inWuhan, China

DaweiWang, MD; Bo Hu, MD; Chang Hu, MD; Fangfang Zhu, MD; Xing Liu, MD; Jing Zhang, MD; BinbinWang, MD; Hui Xiang, MD;
Zhenshun Cheng, MD; Yong Xiong, MD; Yan Zhao, MD; Yirong Li, MD; XinghuanWang, MD; Zhiyong Peng, MD

IMPORTANCE In December 2019, novel coronavirus (2019-nCoV)–infected pneumonia (NCIP)
occurred inWuhan, China. The number of cases has increased rapidly but information on the
clinical characteristics of affected patients is limited.

OBJECTIVE To describe the epidemiological and clinical characteristics of NCIP.

DESIGN, SETTING, AND PARTICIPANTS Retrospective, single-center case series of the 138
consecutive hospitalized patients with confirmed NCIP at Zhongnan Hospital ofWuhan
University inWuhan, China, from January 1 to January 28, 2020; final date of follow-up was
February 3, 2020.

EXPOSURES Documented NCIP.

MAIN OUTCOMES AND MEASURES Epidemiological, demographic, clinical, laboratory,
radiological, and treatment data were collected and analyzed. Outcomes of critically ill
patients and noncritically ill patients were compared. Presumed hospital-related transmission
was suspected if a cluster of health professionals or hospitalized patients in the same wards
became infected and a possible source of infection could be tracked.

RESULTS Of 138 hospitalized patients with NCIP, the median age was 56 years (interquartile
range, 42-68; range, 22-92 years) and 75 (54.3%) were men. Hospital-associated
transmission was suspected as the presumed mechanism of infection for affected health
professionals (40 [29%]) and hospitalized patients (17 [12.3%]). Common symptoms
included fever (136 [98.6%]), fatigue (96 [69.6%]), and dry cough (82 [59.4%]).

Lymphopenia (lymphocyte count, 0.8 × 109/L [interquartile range {IQR}, 0.6-1.1]) occurred in
97 patients (70.3%), prolonged prothrombin time (13.0 seconds [IQR, 12.3-13.7]) in 80
patients (58%), and elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55 patients
(39.9%).
Chest computed tomographic scans showed bilateral patchy shadows or
ground glass opacity in the lungs of all patients. Most patients received antiviral therapy
(oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89
[64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy
(62 [44.9%]). Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU)
because of complications, including acute respiratory distress syndrome (22 [61.1%]),
arrhythmia (16 [44.4%]), and shock (11 [30.6%]). The median time from first symptom to
dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days.
Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102),
were older (median age, 66 years vs 51 years), were more likely to have underlying
comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%]
vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%)
received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17
(47.2%) received invasive ventilation (4 were switched to extracorporeal membrane
oxygenation). As of February 3, 47 patients (34.1%) were discharged and 6 died (overall
mortality, 4.3%), but the remaining patients are still hospitalized. Among those discharged
alive (n = 47), the median hospital stay was 10 days (IQR, 7.0-14.0).

CONCLUSIONS AND RELEVANCE In this single-center case series of 138 hospitalized patients
with confirmed NCIP inWuhan, China, presumed hospital-related transmission of 2019-nCoV
was suspected in 41%of patients, 26%of patients received ICU care, and mortality was 4.3%.
JAMA. doi:10.1001/jama.2020.1585
Published online February 7, 2020. Corrected on February 20, 2020.

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