Keypoints
Background
Methods
Study design and participants
Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 | |
---|---|---|---|---|---|---|
Sex | Male | Male | Male | Male | Male | Male |
Age-ranges, y | 15–20 | 5–10 | 60–70 | 40–50 | 20–30 | 30–40 |
Clinical type | Common | Common | Severe | Severe | Mild | Common |
Maximum temperature, °C | 36.9 | 36.0 | 36.1 | 39.5 | 37.5 | 37.8 |
Diarrhea | No | No | No | No | No | No |
OBT | Negative | Positive | Positive | Negative | Negative | |
Duration of fever, d | 0 | 0 | 0 | 5 | 2 | 10 |
Duration of major symptoms (except fever), d | 0 | 5 | 7 | 4 | 0 | 5 |
Duration of throat swab positive, d | 11 | 9 | 13 | 12 | 2 | 9 |
Duration of anal swab positive, d | 7 | 7 | 9 | 9 | 7 | 7 |
Hospital stays, d | 13 | 15 | 20 | 21 | 5 | 14 |
CT score on admission | 0 | 1 | 17 | 13 | ||
CT score on discharge | 0 | 0 | 14 | 10 | 0 | 0 |
CT score after discharge | 0 | 10 | 7 |
CT scan and image interpretation
Statistical analysis
Results
Clinical characteristics
Total (N = 42) | Anal swab test positive (n = 6) | Anal swab test negative (n = 36) | P Valuea | |
---|---|---|---|---|
Sex | ||||
Female | 25(59.5%) | 6(100.0%) | 19(52.8%) | 0.031 |
Male | 17(40.5%) | 0(0.0%) | 17(47.2%) | |
Age, median (IQR), y | 40(30.8 ~ 46.0) | 28.5(13.3 ~ 50.5) | 42(32 ~ 46) | 0.250 |
>50 | 9(21.4%) | 1(16.7%) | 8(22.2%) | 0.762 |
≤ 50 | 33(78.6%) | 5(83.3%) | 28(77.8%) | |
BMI, median (IQR) | 24.4(22.2 ~ 25.7) | 24.6(16.0 ~ 27.9) | 24.1(22.2 ~ 25.6) | 1.000 |
Epidemiology | ||||
Direct exposure history | 22(52.4%) | 2(33.3%) | 20(55.6%) | 0.148 |
Indirect exposure history | 6(14.3%) | 0(0.0%) | 6(16.7%) | |
Family outbreak | 14(33.3%) | 4(66.7%) | 10(27.8%) | |
Incubation period, median (IQR), d | 7(3 ~ 10) | 9(4.5 ~ 11.3) | 6.5(3 ~ 10) | 0.320 |
Onset of symptom to, median (IQR), d | ||||
Hospital admission | 3.5(2 ~ 6) | 3.0(2 ~ 5.5) | 3.5(2 ~ 6) | 0.697 |
Anal swab test | 27(25 ~ 32.3) | 26.5(21.5 ~ 35.3) | 27(25 ~ 32.3) | 0.836 |
Signs and symptoms | ||||
Fever | 29(69.0%) | 3(50.0%) | 26(72.2%) | 0.281 |
Maximum temperature, median (IQR), °C | 37.7(36.8 ~ 38.5) | 37.2(36.1 ~ 38.2) | 37.9(37.0 ~ 38.7) | 0.235 |
<37·3 | 13(31.0%) | 3(50.0%) | 10(27.8%) | 0.541 |
37·3–38 | 14(33.3%) | 2(33.3%) | 12(33.3%) | |
38·1–39 | 8(19.0%)) | 0(0.0%) | 8(22.2%) | |
>39 | 7(16.7%) | 1(16.7%) | 6(16.7%) | |
Cough | 35(83.3%) | 4(66.7%) | 31(86.1%) | 0.242 |
Dyspnea | 3(7.1%) | 1(16.7%) | 2(5.6%) | 0.333 |
Fatigue | 3(7.1%) | 1(16.7%) | 2(5.6%) | 0.333 |
Myalgia | 5(11.9%) | 0(0.0%) | 5(13.9%) | 0.336 |
Headache | 4(9.5%) | 0(0.0%) | 4(11.1%) | 0.396 |
Nausea and vomiting | 1(2.4%) | 0(0.0%) | 1(2.8%) | 0.683 |
Diarrhea | 6(14.3%) | 0(0.0%) | 6(16.7%) | 0.285 |
No symptoms | 4(9.5%) | 2(33.3%) | 2(5.6%) | 0.034 |
Comorbidities | ||||
Diabetes | 2(4.8%) | 0(0.0%) | 2(5.6%) | 0.558 |
Hypertension | 2(4.8%) | 0(0.0%) | 2(5.6%) | 0.558 |
Hepatitis or liver cirrhosis | 2(4.8%) | 0(0.0%) | 2(5.6%) | 0.558 |
Chronic renal failure | 1(2.4%) | 0(0.0%) | 1(2.8%) | 0.683 |
Malignancy | 1(2.4%) | 0(0.0%) | 1(2.8%) | 0.683 |
Digestive diseases | 3(7.1%) | 1(16.7%) | 2(5.6%) | 0.333 |
Clinical type | ||||
Mild type | 2(4.8%) | 1(16.7%) | 1(2.8%) | 0.701 |
Common type | 30(71.4%) | 3(50.0%) | 27(75.0%) | |
Severe type | 7(16.7%) | 2(33.3%) | 5(13.9%) | |
Critical type | 3(7.1%) | 0(0.0%) | 3(8.3%) | |
Mild + Common type | 32(76.2%) | 4(66.7%) | 28(77.8%) | 0.558 |
Severe + Critical type | 10(23.8) | 2(33.3%) | 8(22.2%) | |
Treatment | ||||
Antibiotic | 29(69.0%) | 3(50.0%) | 26 (72.2%) | 0.281 |
Duration of antibiotic | 6.5(0 ~ 8.3) | 2.5(0 ~ 10.5) | 7.0(0 ~ 8) | 0.562 |
Glucocorticoid | 29(69.0%) | 4(66.7%) | 25(69.4%) | 0.892 |
Duration of glucocorticoid | 4(0 ~ 5) | 4.5(0 ~ 6.5) | 4(0 ~ 5) | 0.739 |
Non-Invasive Ventilation | 3(7.1%) | 1(16.7%) | 2(5.6%) | 0.333 |
Duration of throat swab positive, median (IQR), d | 7.5(5 ~ 10.3) | 10.0(7.3 ~ 12.3) | 7.0(3 ~ 10) | 0.208 |
Duration of fever, median (IQR), d | 5(0.8 ~ 9.3) | 1(0 ~ 6.3) | 6(2 ~ 9.8) | 0.120 |
Duration of major symptoms (except fever), median (IQR), d | 8.5(3.8 ~ 13.3) | 4.5(0 ~ 5.5) | 10.5(4.3 ~ 14) | 0.022 |
Hospital stays, median (IQR), d | 12.5(9 ~ 18) | 14.5(11 ~ 20.3) | 11.5(9 ~ 17.5) | 0.471 |
Laboratory findings
Normal range | Median (IQR) | P Valuea | |||
---|---|---|---|---|---|
Total (N = 42) | Anal swab test positive (n = 6) | Anal swab test positive (n = 36) | |||
Leukocyte count, × 109/L | 3.5 ~ 9.5 | 5.2(3.9 ~ 6.2) | 5.0(3.6 ~ 6.6) | 5.3(4.1 ~ 6.3) | 0.820 |
Lymphocyte count, ×109/L | 0.8 ~ 4 | 1.3(0.9 ~ 1.8) | 1.8(0.6 ~ 2.3) | 1.2(1.0 ~ 1.6) | 0.539 |
lymphocyte percentage, % | 20 ~ 40 | 26.9(20.4 ~ 33.1) | 33.4(17.6 ~ 36.0) | 26.2(20.1 ~ 32.7) | 0.408 |
Haemoglobin, g/L | 130 ~ 175 | 142.5(131.0 ~ 155.5) | 147(134.3 ~ 160.0) | 139(131.0 ~ 154.8) | 0.516 |
Platelet count, ×109/L | 125 ~ 350 | 181(145.8 ~ 231.0) | 234.5(127.5 ~ 305.3) | 179.5(146.3 ~ 223.8) | 0.493 |
ESR, mm/1 h | 0 ~ 15 | 25(11.3 ~ 44.8) | 18(7.1 ~ 36.0) | 26(12.8 ~ 45.3) | 0.210 |
C-reactive protein, mg/L | 0 ~ 6 | 11.3(2.4 ~ 35.2) | 9.3(1.7 ~ 33.3) | 11.3(2.4 ~ 36.6) | 0.471 |
Procalcitonin, μg/L | 0.0 ~ 0.5 | 0.05(0.03 ~ 0.05) | 0.05(0.03 ~ 0.05) | 0.05(0.03 ~ 0.05) | 0.661 |
Total bilirubin, μmol/L | 3.42 ~ 8.2 | 7.2(4.7 ~ 8.7) | 6.5(2.8 ~ 7.5) | 7.5(4.8 ~ 8.9) | 0.159 |
Alanine aminotransferase, U/L | 0 ~ 40 | 25.5(14.0 ~ 40.0) | 30(7.3 ~ 57.5) | 24(15.0 ~ 37.3) | 0.793 |
Aspartate aminotransferase, U/L | 5 ~ 49 | 27.5(22.0 ~ 35.5) | 27.5(22.0 ~ 43.8) | 27.5(22.0 ~ 35.0) | 0.739 |
Albumin, g/L | 60 ~ 85 | 43.7(40.6 ~ 45.9) | 46.1(43.2 ~ 48.2) | 42.7(40.5 ~ 45.5) | 0.075 |
Creatine kinase, U/L | 26 ~ 196 | 91.5(68.8 ~ 133.3) | 108.5(85.5 ~ 195.5) | 90(61.3 ~ 126.3) | 0.281 |
Lactate dehydrogenase, U/L | 109 ~ 245 | 244.5(202.5 ~ 308.5) | 240(193 ~ 290) | 244.5(202.8 ~ 309.5) | 0.586 |
Creatinine, μmol/L | 59 ~ 104 | 61.0(51.5 ~ 70.9) | 60.9(52.0 ~ 64.5) | 62.7(51.2 ~ 71.2) | 0.713 |
Blood urea nitrogen, mmol/L | 1.43 ~ 8.2 | 3.3(2.5 ~ 5.0) | 4.7(4.0 ~ 5.3) | 3.1(1.5 ~ 7.7) | 0.040 |
Glucose, mmol/L | 3.89 ~ 6.11 | 5.6(5.2 ~ 6.8) | 5.0(4.7 ~ 6.6) | 5.7(5.3 ~ 6.9) | 0.123 |
D-dimers, mg/L | 0 ~ 0.55 | 0.3(0.2 ~ 0.4) | 0.3(0.2 ~ 0.5) | 0.3(0.2 ~ 0.4) | 1.000 |
Prothrombin time, s | 9 ~ 14 | 11.4(11.0 ~ 11.9) | 11.0(10.8 ~ 12.9) | 11.4(11.0 ~ 11.9) | 0.586 |
APTT, s | 20 ~ 40 | 26.1(23.7 ~ 28.6) | 26.2(23.1 ~ 30.6) | 26.1(24.5 ~ 27.6) | 0.958 |
Thrombin time, s | 14 ~ 21 | 16.4(15.8 ~ 17.6) | 16.9(15.8 ~ 18.0) | 16.3(15.8 ~ 17.5) | 0.562 |
Fibrinogen, g/L | 2 ~ 4 | 3.4(2.9 ~ 4.5) | 3.1(2.4 ~ 4.5) | 3.5(3.1 ~ 4.5) | 0.314 |
Endotoxin, pg/mL | <10 | 90.4(8.3 ~ 176.0) | 31.4(4.4 ~ 388.9) | 100.7(8.5 ~ 176.0) | 0.576 |
SpO2, % | 91.9 ~ 99.9 | 98(97 ~ 99) | 98(98 ~ 100) | 98(97 ~ 99) | 0.265 |
PaCO2, mmHg | 35 ~ 45 | 37.0(34 ~ 41) | 36.0(33.4 ~ 42.7) | 37.0(34.1 ~ 41.0) | 0.933 |
PaO2:FIO2, mmHg | 400 ~ 500 | 388.1(330.2 ~ 487.1) | 486.2(409.5 ~ 680.1) | 381.0(318.6 ~ 467.8) | 0.040 |
BNP, ng/L | 0 ~ 125 | 50(50 ~ 58.3) | 50(50 ~ 50) | 50(50 ~ 82.3) | 0.600 |
Troponin I, μg/L | 0 ~ 1.68 | 0.8(0.6 ~ 0.9) | 0.8(0.6 ~ 0.9) | 0.8(0.6 ~ 0.9) | 0.741 |
Fecal occult blood test, positive | 4(14.3%) | 2(40%) | 2(8.7%) | 0.135 |
CT findings
Total (N = 31) | Positive (n = 4) | Negative (n = 27) | P Value a | |
---|---|---|---|---|
First CT, negative, (%) | 3(9.7%) | 1(25.0%) | 2(7.4%) | 0.349 |
First CT, positive, (%) | 28(90.3%) | 3(75.0%) | 25(92.6%) | |
Number of involved segments | 9.3 ± 6.1 | 11 ± 8.9 | 9.1 ± 5.9 | 0.726 |
Involvement, (%) | ||||
Single lobe | 5(17.9%) | 1(33.3%) | 4(16.0%) | 0.459 |
Bilateral lobe | 23(82.1%) | 2(66.7%) | 21(84.0%) | |
Distribution, (%) | ||||
Central | 0 | 0 | 0 | – |
Peripheral | 15(53.6%) | 1(33.3%) | 14(56.0%) | 0.583 |
Central + Peripheral | 13(46.4%) | 2(66.7%) | 11(44.0%) | |
Degree, (%) | ||||
Single lesion | 4(14.3%) | 1(33.3%) | 3(12.0%) | 0.217 |
Multiple lesions | 13(46.4%) | 0(0.0%) | 13(52.0%) | |
Diffuse lesions | 11(39.3%) | 2(66.7%) | 9(36.0%) | |
Imaging Features, (%) | ||||
GGO | 27(96.4%) | 1(66.7%) | 25(100.0%) | 0.107 |
Consolidation | 19(67.9%) | 3(100.0%) | 16(64.0%) | 0.530 |
Linear opacities | 19(67.9%) | 2(66.7%) | 17(68.0%) | 1.000 |
Mixed type | 22(78.6%) | 2(66.7%) | 20(80.0%) | 0.530 |
Interstitial change | ||||
Interlobular septal thickening | 3(10.7%) | 1(3.3%) | 2(8.0%) | 0.298 |
Intralobular interstitial thickening | 21(75.0%) | 2(66.7%) | 19(76.0%) | 1.000 |
Other signs, (%) | ||||
Nodule | 8(28.6%) | 1(33.3%) | 7(28.0%) | 1.000 |
Dilatation of vessels | 26(92.9%) | 2(66.7%) | 24(96.0%) | 0.206 |
Bronchial wall thickening | 13(46.4%) | 2(66.7%) | 11(44.0%) | 0.583 |
Air bronchogram | 5(17.9%) | 0(0.0%) | 5(20.0%) | 1.000 |
Crazy-paving pattern | 3(10.7%) | 0(0.0%) | 3(12.0%) | 1.000 |
Halo sign | 7(25.0%) | 1(33.3%) | 6(24.0%) | 1.000 |
Reversed halo sign | 0(0.0%) | 0(0.0%) | 0(0.0%) | – |
Pleural thickening | 4(14.3%) | 0(0.0%) | 4(16.0%) | 1.000 |
Hydrothorax | 0(0.0%) | 0(0.0%) | 0(0.0%) | – |
Lymphadenectasis | 0(0.0%) | 0(0.0%) | 0(0.0%) | – |
CT scores | ||||
On admission | 7.7 ± 4.6 | 10.3 ± 8.3 | 7.4 ± 4.1 | 0.532 |
On discharge | 5.6 ± 3.5 | 8.0 ± 7.2 | 5.3 ± 2.9 | 0.433 |
After discharge | 4.4 ± 2.7 | 8.5 ± 2.1 | 3.8 ± 2.2 | 0.038 |