The clinical warning index of severe COVID-19: discussion based on the clinical features and outcomes of 4 patients.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is spreading worldwide. The onset of severe COVID-19 could lead to multiple organ damage and even death. It is worth paying attention to the warning index of the onset for severe COVID-19 so that patients can be identified and monitored carefully. PATIENTS AND METHODS: The report is a retrospective study that describes and analyzes the clinical features during the treatment of COVID-19. Four patients with COVID-19 were involved in this study, who were father-and-son pairs from two families. All patients were treated with the same combination of anti-microbial and anti-viral agents for 10-14 days, adjusting for the disease status. The primary outcome measure was SARS-CoV-2 detection using RT-qPCR with oropharyngeal swabs. Chest CT imaging served as a secondary outcome measure. RESULTS: One of the four patients progressed to severe disease, while the remaining patients recovered with the same treatment. A persistent decrease in the lymphocyte ratio and increase in the C-reactive protein (CRP) level were observed in the severe patient, along with other typical symptoms of COVID-19. CONCLUSIONS: The cases we described indicate that blood cell and CRP tests could be useful risk warnings of severe onset of COVID-19.

Clinical features of 17 patients with 2019-nCoV.

OBJECTIVE: This study aims to discuss the unique clinical features of patients with 2019-nCoV in Zhengzhou City to provide references for clinical diagnosis and treatment. PATIENTS AND METHODS: Seventeen patients with 2019-nCoV in Zhengzhou People's Hospital from February to March 2020 were collected. Their epidemiology, clinical symptoms, laboratory examinations, and chest CT images were reviewed. All 17 patients were aged between 12-83 years, with an average age of 47 years, and consisted of 10 males (58.8%) and 7 females (41.2%). Two patients had histories of living or traveling in Wuhan, and 9 patients were attacked locally. The 6 remaining patients were unknown about incidence reasons. RESULTS: The average incubation period was 10 days, and the average time of the course of the disease was 9 days. Among the participants, 12 patients had fever as the first symptoms and 5 patients had normal body temperature. One patient was symptom-free carrier, and one patient had serious symptoms. One patient developed from mild symptoms to severe symptoms, and 14 patients had mild symptoms. Moreover, 7 patients had complications of cardiovascular and cerebrovascular diseases and hypertension, 1 patient was in the advanced stage of squamous cell lung carcinoma, and 1 patient had diabetes mellitus, renal failure, and late-stage uremia. According to novel coronavirus nucleic acid test, 8 patients were positive, accounting for 47.1%. All patients were negative in the novel coronavirus IgM antibody test and negative in other common respiratory pathogen detection. All 17 patients had ground glass-like high-density shadow or stripped high-density shadow on lung CT images, accompanied with many affected lesions on two lungs. The average stay in hospital was 10 days, and the average time of the course of the disease was 9 days. After hospitalization, 15 patients were discharged from the hospital upon recovery, 1 patient was transferred to superior hospital for continuous treatment, and 1 patient died. Patients with 2019-nCoV in Zhengzhou People's Hospital were mainly attacked in local areas, and most of them had mild symptoms. The positive rate of the nucleic acid test was 47.1%. CONCLUSIONS: The main clinical characteristics are increased neutrophil granulocytes, increased C-reactive proteins, decreased lymphocytes, ground glass-like or stripped lesions on lung CT image, common complications of cardiovascular and cerebrovascular diseases, and favorable prognosis.