A retrospective study of the clinical diagnosis and treatment of 158 cases of COVID-19

TL;DR

This study analyzed 158 COVID-19 cases in Fujian, China, identifying risk factors like age and lab markers for disease severity and treatment outcomes.

Contribution

The study identifies independent risk factors for severe/critical COVID-19 and provides insights into clinical characteristics and treatment effectiveness in early pandemic cases.

Findings

Most patients had mild/moderate disease with fever and cough as common symptoms.

Older age, elevated white blood cell count, and high D-dimer levels were significant risk factors for severe/critical disease.

Timely treatment including antivirals and traditional Chinese medicine was associated with a high recovery rate.

Abstract

This study aimed to summarize the clinical characteristics, management, and outcomes, and to identify independent risk factors associated with the severity in a cohort of coronavirus disease 2019 (COVID-19) patients from early-pandemic Fujian Province, China.

A total of 158 patients with confirmed COVID-19 were recruited from 10 designed hospitals of the Fujian province between January 22 and February 26, 2020. Their clinical, laboratory, computed tomography imaging, treatment, and outcome data were collected and summarized from electronic medical records. Potential independent risk factors associated with COVID-19 severity were explored by binary logistic multivariate regression.

Of the 158 COVID-19 patients, 36 had mild, 106 had moderate, 8 had severe, and 8 had critical disease severity. The median age was 45 years (interquartile range 35–55) and 81 (51.3%) were men. 8.2% had a history of smoking. 31.6% had chronic underlying conditions, among which hypertension (13.9%), diabetes (7.6%), and liver disease (7.0%) were the most common. The most common initial symptom was fever, followed by cough, sputum expectoration, and muscle soreness. 94.3% of patients had abnormal imaging findings on chest computed tomography or X-ray. Patients with severe/critical disease had significantly more prominent laboratory abnormalities, including an abnormal lymphocyte count and abnormal levels of white blood cells, albumin, aspartate aminotransferase, creatine kinase, lactate dehydrogenase, and D-dimer than mild/moderate patients (all p < 0.05). Independent risk factors associated with severe/critical disease included age ≥ 60 years [Odds ratio (OR) = 19.9], WBC ≥ 10 × 109/L (OR = 47.5) and D-dimer > 0.5 mg/L (OR = 5.0) (p < 0.05). All patients received antiviral drugs; 126 (79.7%) also received traditional Chinese medicine and 29 (18.4%) received glucocorticoids. As of April 2, 133 patients (84.2%) were cured and discharged, 1 individual died (overall mortality, 0.6%), and the remaining 24 (15.2%) remained hospitalized after data gathering was completed.

COVID-19 patients from Fujian province during early pandemic presented mostly as mild/moderate cases with fever and cough as the initial symptoms. The detection of cellular immune function, coagulation function, myocardial damage, and liver function can help assess the severity of COVID-19. Specifically, the most important risk factors were older age, WBC elevation, and D-dimer elevation. Timely comprehensive treatment might be beneficial in controlling COVID-19.

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