ABSTRACT
Background: The stage of CT images was rarely studied and the relationship between the severity of Coronavirus Disease 2019 (COVID-19) and CT images has not been studied based on systematic quantitative analysis currently. Purpose: To investigate the staging duration and classification of CT images of patients with COVID-19 based on quantitative analysis. Materials and Methods: This is an ambispective observational cohort study based on 125 patients with COVID-19 from Jan 23 to Feb 28, 2020. The stage of CT and pulmonary lesion size were quantitatively analyzed. The categorical regression analysis based on optimal scale (CATREG) was performed to evaluate the association of CT score, age, and gender with the clinical type. Results: The CT images of 125 patients with COVID-19 (50.13 plus-or-minus 16.91 years, 66 women) were analyzed in this study. Except for pre-early stage, the duration of early, progression-consolidation, and dissipation stage of CT images was 3.40 plus-or-minus 2.31, 10.07 plus-or-minus 4.91, and 20.60 plus-or-minus 7.64 days, respectively. The median CT score was 5.00 (2.00-8.50) during the first 30 days, which reached a peak on the 11th day. Significant differences were found between the median CT scores of different clinical types (P less than 0.05). Besides, the age was correlated with the clinical type (P less than 0.001), the CT scores of 0.00-11.50, 11.50-16.00, and 16.00-20.00 were separately correlated with the moderate, severe, and critical type with the output accuracy 69.60%. Conclusion: The four-stage staging method based on quantitative analysis is consistent with the change rules of staging features and COVID-19. Quantitative study by scoring pulmonary lesion sizes accurately revealed the evolvement of pulmonary lesions and differences between different clinical types.
Subject(s)
COVID-19 , Lung DiseasesABSTRACT
Background The pandemic of coronavirus disease 2019 (COVID-19) has become the first concern in international affairs as the novel coronavirus (SARS-CoV-2) is spreading all over the world at a terrific speed. The accuracy of early diagnosis is critical in the control of the spread of the virus. Although the real-time RT-PCR detection of the virus nucleic acid is the current golden diagnostic standard, it has high false negative rate when only apply single test. Objective Summarize the baseline characteristics and laboratory examination results of hospitalized COVID-19 patients. Analyze the factors that could interfere with the early diagnosis quantitatively to support the timely confirmation of the disease. Methods All suspected patients with COVID-19 were included in our study until Feb 9th, 2020. The last day of follow-up was Mar 20th, 2020. Throat swab real-time RT-PCR test was used to confirm SARS-CoV-2 infection. The difference between the epidemiological profile and first laboratory examination results of COVID-19 patients and non-COVID-19 patients were compared and analyzed by multiple logistic regression. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to assess the potential diagnostic value in factors, which had statistical differences in regression analysis. Results In total, 315 hospitalized patients were included. Among them, 108 were confirmed as COVID-19 patients and 207 were non-COVID-19 patients. Two groups of patients have significance in comparing age, contact history, leukocyte count, lymphocyte count, C-reactive protein, erythrocyte sedimentation rate (p<0.10). Multiple logistic regression analysis showed age, contact history and decreasing lymphocyte count could be used as individual factor that has diagnostic value (p<0.05). The AUC of first RT-PCR test was 0.84 (95% CI 0.73-0.89), AUC of cumulative two times of RT-PCR tests was 0.92 (95% CI 0.88-0.96) and 0.96 (95% CI 0.93-0.99) for cumulative three times of RT-PCR tests. Ninety-six patients showed typical pneumonia radiological features in first CT scan, AUC was 0.74 (95% CI 0.60-0.73). The AUC of patients age, contact history with confirmed people and the decreased lymphocytes were 0.66 (95% CI 0.60-0.73), 0.67 (95% CI 0.61-0.73), 0.62 (95% CI 0.56-0.69), respectively. Taking chest CT scan diagnosis together with patients age and decreasing lymphocytes, AUC would be 0.86 (95% CI 0.82-0.90). The age threshold to predict COVID-19 was 41.5 years, with a diagnostic sensitivity of 0.70 (95% CI 0.61-0.79) and a specificity of 0.59 (95% CI 0.52-0.66). Positive and negative likelihood ratios were 1.71 and 0.50, respectively. Threshold of lymphocyte count to diagnose COVID-19 was 1.53x109/L, with a diagnostic sensitivity of 0.82 (95% CI 0.73-0.88) and a specificity of 0.50 (95% CI 0.43-0.57). Positive and negative likelihood ratios were 1.64 and 0.37, respectively. Conclusion Single RT-PCR test has relatively high false negative rate. When first RT-PCR test show negative result in suspected patients, the chest CT scan, contact history, age and lymphocyte count should be used combinedly to assess the possibility of SARS-CoV-2 infection.
Subject(s)
COVID-19 , PneumoniaABSTRACT
Backgroud: To describe the frequency and distribution characteristics of gastrointestinal symptoms of coronavirus disease 2019 (COVID-19) patients.Methods: As a cohort study, all confirmed COVID-19 patients with gastrointestinal symptoms at Xiangyang No.1 people’s hospital were included until February 21st, 2020. Course of disease no less than 21 days.Gastrointestinal symptoms relevant data were extracted and analyzed. The frequency histograms of the symptoms were plotted. Main symptom characteristics were summarized.Results: Of 50 included patients with gastrointestinal symptoms, 21 were male, 29were female. The mean age was 53 (SD 16) years. Course of disease ranged from 21 to 34 days with a median of 26 days. Among all patients, 16 were critically ill and five died, 12 discharged. Thirty-one clinical symptoms occurred 3168 times in total, 6 gastrointestinal symptoms occurred 439 (13.86%) times and 25 non-gastrointestinal symptoms occurred 2 729(86.14%) times. All symptoms and non-gastrointestinal symptoms distributed in 1 to 34 days, reached peak on 6th day of follow up, first seven days were the fastigium and decreasing in the rest days. Gastrointestinal symptoms mainly distributed in 1 to 34 days, reached a peak of 36 times per day on 6th of follow-up with a fastigium during 6 to 12 day, showed a trend of rise first and then fall. Nausea, vomit and abdominal discomfort occurred 133, 70 and 62 times, respectively.Conclusions: A symptom frequency to time distribution model could describe the disease process quantitatively, indicating the change law of gastrointestinal symptoms and the organ damages in gastrointestinal system, could help us to better understand and treat the new disease. Females showed higher incidence of gastrointestinal symptoms, whether there is a sex difference in susceptibility needs to be further confirmed.Trial regitration: retrospectively registeredAuthors Guoxin Huang and Shengduo Pei contributed equally to this work.
Subject(s)
Coronavirus Infections , Signs and Symptoms, Digestive , Nausea , Vomiting , COVID-19ABSTRACT
Summary Objective To describe the epidemiological and clinical characteristics of the Coronavirus Disease 2019 (COVID-19) hospitalized patients and to offer suggestions to the urgent needs of COVID-19 prevention, diagnosis and treatment. Methods We included 102 confirmed COVID-19 cases hospitalized in Xiangyang No.1 peoples hospital, Hubei, China until Feb 9th, 2020. Demographic data, laboratory findings and chest computed tomographic (CT) images were obtained and analyzed. Findings All cases were confirmed by real-time RT-PCR, including 52 males and 50 females with a mean age of 50.38 years (SD 16.86). Incubation time ranged from one to twenty days with a mean period of 8.09 days (SD 4.99). Fever (86[84.3%] of 102 patients), cough (58[57%]), fatigue (28[27%]), shortness of breath (24[23%]), diarrhea (15[15%]), expectoration (13[12%]), inappetence (11[10%]) were common clinical manifestations. We observed a decreased blood leukocyte count and lymphopenia in 21 (20.6%) and 56 (54.9%) patients, respectively. There were 66 (68%) of 97 patients with elevated C-reactive protein levels and 49 (57.6%) of 85 with increased erythrocytes sedimentation rate. Higher levels of procalcitonin and ferritin were observed in 19 (25.3%) of 75 and 12 (92.3%) of 13 patients, respectively. Eight patients were admitted to intensive care unit (ICU), six developed respiratory failure, three had multiple organ failure and three died. The cumulative positivity rate over three rounds of real-time RT-PCR was 96%. One-hundred patients were found with typical radiological abnormalities in two rounds of chest CT scans, indicating a 98% consistency with real-time RT-PCR results. Interpretation Most COVID-19 patients in Xiangyang were secondary cases without sex difference, and the rate of severe cases and death was low. Middle-to-old-age individuals were more susceptible to the virus infection and the subsequent development of severe/fatal consequences. The average incubation period was longer among our patients. We recommend prolonging the quarantine period to three weeks. Three times real-time RT-PCR plus two times CT scans is a practical clinical diagnosis strategy at present and should be used to increase the accuracy of diagnosis, thereby controlling the source of infection more effectively. Key Words SARS-CoV-2; COVID-19; epidemiological and clinical features; diagnosis