Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China

Abstract

Please cite this article as: Liang W-hua, Guan W-jie, Li C-chen, et al. Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicenter) and outside Hubei (non-epicenter): A Nationwide Analysis of China. Eur Respir J 2020; in press (https://doi.Abstract BACKGROUND: During the outbreak of coronavirus disease 2019 (COVID-19), consistent and considerable differences in disease severity and mortality rate of patients treated in Hubei province compared to those in other parts of China has been observed. We sought to compare the clinical characteristics and outcomes of patients being treated inside and outside Hubei province, and explore the factors underlying these differences. METHODS:Collaborating with the National Health Commission, we established a retrospective cohort to study hospitalized COVID-19 cases in China. Clinical characteristics, the rate of severe events and deaths, and the time to critical illness (invasive ventilation or intensive care unit admission or death) were compared between patients in and outside of Hubei. The impact of Wuhan-related exposure (a presumed key factor that drove the severe situation in Hubei, as Wuhan is the epicenter as well the administrative center of Hubei province) and the duration between symptom onset and admission on prognosis were also determined. RESULTS:Upon data cut-off (Jan 31st, 2020), 1,590 cases from 575 hospitals in 31 provincial administrative regions were collected (core cohort). The overall rate of severe cases and mortality was 16.0% and 3.2%, respectively. Patients in Hubei (predominantly with Wuhan-related exposure, 597/647, 92.3%) were older (mean: 49.7 vs. 44.9 years), had more cases with comorbidity (32.9% vs. 19.7%), higher symptomatic burden, abnormal radiologic manifestations, and, especially, a longer waiting time between symptom onset and admission (5.7 vs. 4.5 days) compared with patients outside Hubei. Patients in Hubei [severe event rate 23.0% vs. 11.1%, death rate 7.3% vs. 0.3%, hazards ratio (HR) for critical illness 1.59, 95%CI 1.05-2.41] have a poorer prognosis compared with patients outside of Hubei after adjusting for age and comorbidity. However, among patients outside of Hubei, the duration from symptom onset to hospitalization (mean: 4.4 vs. 4.7 days) and prognosis (HR 0.84, were similar between patients with or without Wuhan-related exposure. In the overall population, the waiting time, but neither treated in Hubei nor Wuhan-related exposure, remained an independent prognostic factor (HR 1.05, 1.01-1.08).CONCLUSION: There were more severe cases and poorer outcomes for COVID-19 patients treated in Hubei, which might be attributed to the prolonged duration of symptom onset to hospitalization in the epicenter. Future studies to determine the reason for delaying hospitalization are warranted.

Clinical characteristics and prognostic factors in elderly patients with COVID-19

“…The symptom of dyspnea with an increased respiratory rate and a decreased S p O 2 level were signi cantly prevalent in non-survival group, indicating a poor prognosis. 75.3% patients had at least one comorbidity, which is a higher rate than that of COVID-19 patients overall [7][8][9][10]. 32.8% of patients were diagnosed with diabetes in this study, which is higher than that in previous data [3,5].…”

“…Patients in Hubei have poorer prognosis compared with those outside Hubei (severe event rate was 23.0% vs 11.1%, and mortality rate was 7.3% vs 0.3%.) [7]. In this study, among elderly COVID-19 patients, 64.5% were classi ed as severe or critical type, and the mortality rate was 16.1%, which is higher than previous studies.…”

“…The ADL scores in non-survival group were lower with mean value less than 60, indicating that these patients could not ful ll daily activities and relied highly on caregivers. It has been reported that time from symptom onset to hospitalization was an independent risk factor for prognosis [7]. In this study, the time from illness onset to admission in non-survival group was slightly shorter than that of the survival group.…”

Predicting mortality due to SARS-CoV-2: A mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico

“…The relationship between increased risk of mortality attributable to acute severe respiratory infections in patients with diabetes mellitus has been extensively reported, particularly for the Italy [5,23,24]. Increased susceptibility for COVID-19 in patients with diabetes may be explained for several potential mechanisms including an increased lung ACE2 expression and elevated circulating levels of furin, a protease involved in viral entry to cells, and a decreased clearance of SARS-CoV-2 viral particles in subjects with diabetes and/or hypertension associated with ACE2 expression [25][26][27][28].…”

Antibody therapies for the treatment of COVID-19

“…One challenge for developing COVID-19 therapies is the complexity of pathology and immunology associated with SARS-CoV-2 infection and its comorbidities. The vast majority of deaths have occurred in patients with underlying conditions [69]. Considerations for designing clinical trials for SARS-CoV-2 therapies include optimization of dose and dosing frequency, disease stage at which to administer therapy, and combination with other therapies.…”