Clinical Characteristics,Prognosis And Follow-up Analysis Of 82 COVID-19 Patients

Objective:The epidemiological features,hospitalization and follow-up data of eighty two novel Coronavirus pneumonia cases of Shaoyang,Hunan,China,were collected and analyzed in the year of 2020.To explore possible risk factors for COVID-19 patients progressed to severe category,in order to identify severe patients early and provide prompt intervening treatment,reducing the incidence of severe cases and medical resources waste;exploring the reasons why patients’ nucleic acid test re-positive after discharge,so as to provide reference for epidemic prevention and control.Methods:A retrospective study was used in this study.The data of 82 confirmed COVID-19 patients,who were hospitalized in Shaoyang Central Hospital from January 23 to March 2,2020,were collected by consulting the hospital electronic medical record system,hospital imaging system,telephone follow-up,We Chat follow-up and other methods,and then we use that data to analyze clinical characteristics.The data includes:(1)Basic information of the patient at admission,(2)clinical manifestations of the patient,(3)laboratory data,(4)imaging data,(5)treatment,(6)clinical outcomes,etc.82 patients were divided into ordinary group(including mild type and normal type)and severe group(including heavy type and critical type).Chi-square test,T test,Fisher’s exact probability test and non-parametric test were used to compare the clinical manifestations,characteristics of laboratory data,treatment process and nucleic acid test results between the two groups.Result:1.Of the 82 confirmed COVID-19 patients,42(51.22%)cases were males and 40(48.78%)cases were females.39 cases(47.56%)had a history of residence or travel in Wuhan,35 cases(42.68%)had been in contact with novel coronavirus pneumonia within 14 days before the onset of the disease,and 15 cases(18.29%)had no definite epidemiological history.49 cases(59.76%)were clustered,and 45 cases(54.88%)were infected by contact with relatives or friends.32 cases(39.02%)were from Shaodong(county-level city),and 16 cases(19.51%)were from Xinshao County.There were 69 cases of fever(84.14%),71 cases of cough(86.59%),35 cases of expectoration(42.68%),32 cases of dyspnea(39.02%),49 cases of fatigue(59.76%),29 cases of myalgia(35.37%),16 cases of headache(19.51%)and 7 cases of diarrhea(8.50%).First CT scan of the Lungs on admission showed 77 cases(93.90%)of Ground-Glass Opacity,3 cases(3.65%)of localized patchy shadow,1case(1.2%)of pleural effusion,no case of mediastinal lymphadenectasis,61 cases(74.39%)of bilateral lung involvement.14(22.95%)cases of fibrotic lesion on the 14 th day after discharge,16(26.22%)cases of fibrotic lesion on the 28 th day after discharge.Eighty-one patients recovered(98.78%)and one died(1.22%).2.Compared with ordinary group,there were more patients in severe group with older age of onset(P<0.001),underlying diseases(cardiovascular disease or diabetes)(P<0.001),decreased lymphocyte count(P<0.05),and increased CRP index and D-dimer index(P<0.01).The levels of CRP and D-dimer were significantly increased(P<0.05);Lung CT examination at the first admission was more likely to show double lung involvement(P<0.01).During hospitalization,the number of antibiotics,immunoglobulin,hormone and oxygen therapy was more than that of the ordinary group(P< 0.001);Average length of hospital stay was longer(P< 0.05).Fourteen days after discharge,patients in the severe group had lower lymphocyte counts than those in the ordinary group(P< 0.05),and more people showed decreased index(P< 0.05);28 days after discharge,more patients in the ordinary group were found to have total absorption of lesions by lung CT examination than those in the severe group(P< 0.05).3.6 patients’ nucleic acid test re-positive after discharge,including 3 males(50%)and 3 females(50%),with an average age of42.5 years and no underlying diseases.6 patients had cough(100%),4had fever(66.67%),3 had shortness of breath(50%),1 had expectoration(16.67%),and 1 had fatigue(16.67%).6 cases were ordinary type patients with clustered disease(100%),including 4 cases in Wuhan(66.67%)and 2 cases in local second-generation cluster(33.33%).Nucleic acid tests showed that 3 nasopharyngeal swabs were positive,3anal swabs were positive,and none were positive for both nasopharyngeal and anal swabs.The longest time from onset to negative nucleic acid was37 days for nasopharyngeal swabs and 50 days for anal swabs.Conclusion :(1)The majority of COVID-19 cases in Shaoyang are imported cases and second-generation associated cases in Wuhan,with clustering characteristics,and there is no difference in incidence between males and females.Patients may develop pulmonary fibrosis in the early stages of recovery.(2)Advanced age,combined underlying diseases(cardiovascular disease or diabetes),lower lymphocyte count,higher CRP index,and higher D-dimer index are related factors for COVID-19 patients progressed to severe category,which should be early intervention.(3)There were a few cases with mild symptoms of repositive,which was considered to be related to intermittent detoxification or false negative nucleic acid,and the length of detoxification in nucleic acid tests of different types of specimens varied.