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1.
Lu  H, Stratton  CW, Tang  YW.  Outbreak of pneumonia of unknown etiology in Wuhan China: the mystery and the miracle  [published January 16, 2020].  J Med Virol. 2020. doi:10.1002/jmv.25678PubMedGoogle Scholar
2.
Hui  DS, I Azhar  E, Madani  TA,  et al.  The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health: the latest 2019 novel coronavirus outbreak in Wuhan, China  [published January 14, 2020].  Int J Infect Dis. 2020;91:264-266. doi:10.1016/j.ijid.2020.01.009PubMedGoogle ScholarCrossref
3.
Wuhan Municipal Health Commission. Report of novel coronavirus-infected pneumonia in China. Published January 20, 2020. Accessed January 31, 2020. http://wjw.wuhan.gov.cn/front/web/showDetail/2020012009077
4.
Paules  CI, Marston  HD, Fauci  AS.  Coronavirus infections—more than just the common cold  [published January 23, 2020].  JAMA. doi:10.1001/jama.2020.0757Google Scholar
5.
Wuhan Municipal Health Commission. Report of clustering pneumonia of unknown etiology in Wuhan City. Published December 31, 2019. Accessed January 31, 2020. http://wjw.wuhan.gov.cn/front/web/showDetail/2019123108989
6.
World Health Organization. Novel coronavirus(2019-nCoV): situation report—15. Accessed February 5, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200204-sitrep-15-ncov.pdf
7.
Zhu  N, Zhang  D, Wang  W,  et al; China Novel Coronavirus Investigating and Research Team.  A novel coronavirus from patients with pneumonia in China, 2019  [published January 24, 2020].  N Engl J Med. doi:10.1056/NEJMoa2001017PubMedGoogle Scholar
8.
Chen  N, Zhou  M, Dong  X,  et al.  Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study  [published January 29, 2020].  Lancet. doi:10.1016/S0140-6736(20)30211-7PubMedGoogle Scholar
9.
Huang  C, Wang  Y, Li  X,  et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China  [published January 24, 2020].  Lancet. doi:10.1016/S0140-6736(20)30183-5PubMedGoogle Scholar
10.
Chan  JF-W, Yuan  S, Kok  K-H,  et al.  A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster  [published January 24, 2020].  Lancet. 2020;S0140-6736(20)30154-9. doi:10.1016/S0140-6736(20)30154-9PubMedGoogle Scholar
11.
Phan  LT, Nguyen  TV, Luong  QC,  et al.  Importation and human-to-human transmission of a novel coronavirus in Vietnam  [published January 28, 2020].  N Engl J Med. doi:10.1056/NEJMc2001272PubMedGoogle Scholar
12.
World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. Published January 28, 2020. Accessed January 31, 2020. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
13.
Ranieri  VM, Rubenfeld  GD, Thompson  BT,  et al; ARDS Definition Task Force.  Acute respiratory distress syndrome: the Berlin definition.  JAMA. 2012;307(23):2526-2533. doi:10.1001/jama.2012.5669PubMedGoogle Scholar
14.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group.  KDIGO Clinical Practice Guideline for Acute Kidney Injury.  Kidney Int Suppl. 2012;2:1.Google ScholarCrossref
15.
Li  Q, Guan  X, Wu  P,  et al.  early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia.  [published on January 29, 2020].  N Engl J Med. 2020. doi:10.1056/NEJMoa2001316PubMedGoogle Scholar
16.
Zhang  H, Kang  ZJ, Gong  HY,  et al.  The digestive system is a potential route of 2019 nCoV infection: a bioinformatics analysis based on single-cell transcriptomes.  Preprint. Posted online January 31, 2020. bioRxiv 927806. doi:10.1101/2020.01.30.927806
17.
de Wit  E, van Doremalen  N, Falzarano  D, Munster  VJ.  SARS and MERS: recent insights into emerging coronaviruses.  Nat Rev Microbiol. 2016;14(8):523-534. doi:10.1038/nrmicro.2016.81PubMedGoogle ScholarCrossref
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Original Investigation
Caring for the Critically Ill Patient
February 7, 2020

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

Author Affiliations
  • 1Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
  • 2Department of Pulmonary Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
  • 3Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
  • 4Department of Emergency Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
  • 5Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
  • 6Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
JAMA. Published online February 7, 2020. doi:10.1001/jama.2020.1585
Key Points

Question  What are the clinical characteristics of hospitalized patients with 2019 novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) in Wuhan, China?

Findings  In this single-center case series involving 138 patients with NCIP, 26% of patients required admission to the intensive care unit and 4.3% died. Presumed human-to-human hospital-associated transmission of 2019-nCoV was suspected in 41% of patients.

Meaning  In this case series in Wuhan, China, NCIP was frequently associated with presumed hospital-related transmission, 26% of patients required intensive care unit treatment, and mortality was 4.3%.

Abstract

Importance  In December 2019, novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, 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 of Wuhan University in Wuhan, 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 in Wuhan, 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%.

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