On March 9, the international medical journal The Lancet published online a cohort study by Chinese doctors on the clinical processes and risk factors of death in patients with new coronary pneumonia (COVID-19) in Wuhan. adult inpatients with COVID-19 in Wuhan, China: aretrospective cohort study.
The study, the first to describe new data on the detoxification of the new coronavirus, covers 191 patients (137 discharged and 54 died). The median survivor’s rejection of the new coronavirus lasts 20 days, but is detected in patients who have tragically died until they die. The maximum detox time observed by the researchers was 37 days.
The study was led by Cao Bin, vice president of the Sino-Japanese Friendship Hospital, and included Liu Zhibo, Ph.D., of Jinyintan Hospital in Wuhan. The study is the latest observation of 191 adult patients diagnosed with new coronary pneumonia in two hospitals in Wuhan (135 cases in Jinyintan Hospital, Wuhan City and 56 cases in Wuhan Lung Hospital). The interception time is 29 December 2019 and discharge or death by 31 January 2020.
Studies have shown that patients with new coronary pneumonia have been hospitalized for longer than expected virus detoxification, but the authors suggest that the true duration of virus detoxification in all patients remains unclear given the severe illness, limited samples and genetic material tested in patients in the study.
Age, symptoms of sepsis, and clotting at hospital are key risk factors associated with high risk of death from neo-coronavirus. The new study examines for the first time risk factors for serious illness and death associated with the eventual discharge or death of hospitalized adults. Of the 191 patients, 137 were discharged from hospital and 54 died in hospital. The authors note that the explanations for their findings may be limited by the study sample size.
In addition, the authors provided new data on virus detox, which showed that the median duration of virus detox in survivors was 20 days (ranging from 8 to 37 days) and that the virus could be detected in 54 non-survivors up to death.
Although prolonged viral detoxation suggests that patients may still be able to transmit the new coronavirus, the authors say the duration of the virus detox is affected by the severity of the disease, noting that all patients in the study have been hospitalized, with two-thirds of them having a combination of severe or significant diseases. In addition, the estimated duration of viral detoxification is limited by the low frequency of collection of respiratory specimens and the lack of measurable genetic material testing in the samples.
“In our study, we found that prolonged release of the virus was of great guidance for isolation precautions and antiviral therapy for patients with confirmed neo-coronary pneumonia infection. However, we need to make it clear that for asymptomatic people with neo-coronary pneumonia, the time of virus detoxification should not be confused with other self-isolation guidelines, which are based on the latent time of the virus. Cao Bin, vice president of the Sino-Japanese Friendship Hospital, explained.
The figure shows the main symptoms, outcomes, and time of virus detoxification in hospitalized patients who survived and died. There are also the median duration of the main symptoms, the start time and the result of the complications.
ICU – Intensive Care Unit SARS-CoV-2 – Severe Acute Respiratory Syndrome Coronary Virus 2 ARDS – Acute Respiratory Distress Syndrome COVID-19 – New Coronary Virus Pneumonia
This study is the first to describe the full picture of the progression of neo-coronary pneumonia. The median fever time of the survivors was about 12 days, similar to that of non-survivors. But survivors’ coughs can last a long time, and 45 percent of survivors still cough after discharge. Among the survivors, breathing difficulties (shortness of breath) will stop after about 13 days, but will continue until non-survivors die. The study also describes the time when different complications occur, such as sepsis, acute respiratory distress syndrome (ARDS), acute heart damage, acute kidney injury, and secondary infection.
During the study, the researchers compared clinical records, treatment data, laboratory results, and demographic data between discharged survivors and non-survivors. They studied symptoms during hospitalization, viral detoxification and clinical processes of laboratory test results (e.g., blood tests, chest X-rays and CT scans), and used mathematical models to examine risk factors associated with hospital deaths.
On average, the study noted that the patients were middle-aged (median age 56 years), the majority were male (62%, 119 patients), about half had potential chronic diseases (48 percent, 91 patients), and the most common were combined with high blood pressure (30 percent, 58 patients) and diabetes (19 percent, 36 cases).
From the onset of the disease, the average time of discharge was 22 days and the average time of death was 18.5 days. The patients who died were older than survivors (average age was 69 vs 52 years old) and scored higher on sequential organ failure assessment (SOFA), with elevated blood concentrations of sepsis and d-dipolyproteins at hospital admission (coagulation indicator).
The authors also note some limitations of the study, including the exclusion of patients who remain in hospitals after January 31, 2020, and the relatively severe illness of patients in the early stages of the outbreak, which does not reflect the true mortality rate of neo-coronary pneumonia. They also point out that not all patients have undergone all laboratory tests (e.g. d-d-dipolymer examinations) and may therefore underestimate their exact role in predicting hospital deaths. Finally, the lack of effective antiviral drugs, inadequate compliance with standard support therapies, and high doses of corticosteroid hormones, as well as the transfer of some patients to hospitals at a late stage of the disease, can lead to poor prognosis in some patients.