Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit.
底特律大都市一系列患者中与冠状病毒疾病 2019 相关的临床特征和发病率。
- 作者列表："Suleyman G","Fadel RA","Malette KM","Hammond C","Abdulla H","Entz A","Demertzis Z","Hanna Z","Failla A","Dagher C","Chaudhry Z","Vahia A","Abreu Lanfranco O","Ramesh M","Zervos MJ","Alangaden G","Miller J","Brar I
Importance:In late December 2019, an outbreak caused by a novel severe acute respiratory syndrome coronavirus 2 emerged in Wuhan, China. Data on the clinical characteristics and outcomes of infected patients in urban communities in the US are limited. Objectives:To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and to perform a comparative analysis of hospitalized and ambulatory patient populations. Design, Setting, and Participants:This study is a case series of 463 consecutive patients with COVID-19 evaluated at Henry Ford Health System in metropolitan Detroit, Michigan, from March 9 to March 27, 2020. Data analysis was performed from March to April 2020. Exposure:Laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. Main Outcomes and Measures:Demographic data, underlying comorbidities, clinical presentation, complications, treatment, and outcomes were collected. Results:Of 463 patients with COVID-19 (mean [SD] age, 57.5 [16.8] years), 259 (55.9%) were female, and 334 (72.1%) were African American. Most patients (435 [94.0%]) had at least 1 comorbidity, including hypertension (295 patients [63.7%]), chronic kidney disease (182 patients [39.3%]), and diabetes (178 patients [38.4%]). Common symptoms at presentation were cough (347 patients [74.9%]), fever (315 patients [68.0%]), and dyspnea (282 patients [60.9%]). Three hundred fifty-five patients (76.7%) were hospitalized; 141 (39.7%) required intensive care unit management and 114 (80.8%) of those patients required invasive mechanical ventilation. Male sex (odds ratio [OR], 2.0; 95% CI, 1.3-3.2; P = .001), severe obesity (OR, 2.0; 95% CI, 1.4-3.6; P = .02), and chronic kidney disease (OR, 2.0; 95% CI, 1.3-3.3; P = .006) were independently associated with intensive care unit admission. Patients admitted to the intensive care unit had longer length of stay and higher incidence of respiratory failure and acute respiratory distress syndrome requiring invasive mechanical ventilation, acute kidney injury requiring dialysis, shock, and mortality (57 patients [40.4%] vs 15 patients [7.0%]) compared with patients in the general practice unit. Twenty-nine (11.2%) of those discharged from the hospital were readmitted and, overall, 20.0% died within 30 days. Male sex (OR, 1.8; 95% CI, 1.1-3.1; P = .03) and age older than 60 years (OR, 5.3; 95% CI, 2.9-9.7; P < .001) were significantly associated with mortality, whereas African American race was not (OR, 0.98; 95% CI, 0.54-1.8; P = .86). Conclusions and Relevance:In this review of urban metropolitan patients with COVID-19, most were African American with a high prevalence of comorbid conditions and high rates of hospitalization, intensive care unit admission, complications, and mortality due to COVID-19.
重要性: 2019 年 12 月下旬，中国武汉出现了一场由新型新型冠状病毒引起的疫情。美国城市社区感染患者的临床特征和结局数据有限。 目的: 描述冠状病毒病 2019 (新型冠状病毒肺炎) 患者的临床特征和转归，并对住院和门诊患者人群进行比较分析。 设计、地点和参与者: 本研究是一个连续的 463 例新型冠状病毒肺炎患者的病例系列，这些患者于 2020 年 3 月 9 日至 3 月 27 日在密歇根州底特律的亨利福特健康系统进行了评估。从 2020 年 3 月至 4 月进行数据分析。 暴露: 实验室证实的新型冠状病毒感染。 主要结局和指标: 收集人口统计学数据、基础合并症、临床表现、并发症、治疗和结局。 结果: 463 例新型冠状病毒肺炎患者 (平均 [SD] 年龄，57.5 [16.8] 岁) 中，259 例 (55.9%) 为女性，334 例 (72.1%) 为非裔美国人。大多数患者 (435 [94.0%]) 至少有 1 种合并症，包括高血压 (295 例 [63.7%]) 、慢性肾脏病 (182 例 [39.3%]) 、和糖尿病 (178 例患者 [38.4%])。就诊时常见症状为咳嗽 (347 例 [74.9%]) 、发热 (315 例 [68.0%]) 和呼吸困难 (282 例 [60.9%])。76.7% 例患者 (141) 住院; 39.7% 例 (114) 需要重症监护病房管理，其中 80.8% 例 () 需要有创机械通气。男性 (比值比 [OR]，2.0; 95% CI，1.3-3.2; P =.001)，重度肥胖 (OR，2.0; 95% CI，1.4-3.6; P =.02) 和慢性肾脏病 (OR，2.0; 95% CI，1.3-3.3; P =.006) 与重症监护室入院独立相关。入住重症监护病房的患者住院时间较长，需要有创机械通气的呼吸衰竭和急性呼吸窘迫综合征、需要透析的急性肾损伤、休克、与普通医疗单位的患者相比，死亡率 (57 例 [40.4%] vs 15 例 [7.0%])。29 例 (11.2%) 出院患者再次入院，总体上 20.0% 在 30 天内死亡。男性 (OR，1.8; 95% CI，1.1-3.1; P =.03) 和年龄大于 60 岁 (OR，5.3; 95% CI，2.9-9.7; P <.001) 与死亡率显著相关，而非裔美国人种族不相关 (OR，0.98; 95% CI，0.54-1.8; P =.86)。 结论和相关性: 在这篇关于新型冠状病毒肺炎的都市患者的综述中，大多数是非裔美国人，共病患病率高，住院率高，重症监护病房住院率，并发症，和死亡率由于新型冠状病毒肺炎。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.