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Objective: A large number of patients had infected by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). We aimed to clarify the clinical features of the patients without fever infected by SARS-CoV-2.Methods: This is a retrospective and single-center study. We collected and analyzed the data of demographic, clinical presentation, laboratory tests, radiological results, treatment, and complications. The patients with fever and without fever were compared.Results: 113 patients were enrolled in the study, 36 (31.9%) patients without fever on admission. Among the patients without fever, the mean age was 41 years (IQR, 30-53; Range, 8-82years) and 18 (50%) were male. The median from the onset of illness to the first admission was 3.0 days. None of the patients without fever had complications and received high-flow oxygen therapy or invasive ventilation. As of Feb 22, 2020, 8 patients (22.2%) were discharged, and the remaining patients were still hospitalized. Conclusions: Out of 113 patients with SARS-COV-2 infection, patients without fever accounted for 31.9% in total. The clinical prognosis of patients without fever may be better than those of patients with fever on admission.
Subject(s)
COVID-19ABSTRACT
Background: Acute respiratory distress syndrome (ARDS) was the most common complication of coronavirus disease-2019(COVID-19), leading to poor clinical outcomes. However, the model to predict the in-hospital incidence of ARDS in patients with COVID-19 is limited. Therefore, we aimed to develop a predictive nomogram for the in-hospital incidence of ARDS in COVID-19 patients.Methods: Patients with COVID-19 admitted to Changsha Public Health Centre between Jan 30, 2020, and Feb 22, 2020, were enrolled. Clinical characteristics and laboratory variables were analyzed in patients with ARDS. Risk factors for ARDS were selected by LASSO binary logistic regression. Nomogram was established based on risk factors and validated by the dataset.Results: A total of 113 patients, involving 99 in the non-ARDS group and 14 in the ARDS group were included in the study. 8 variables including hypertension, chronic obstructive pulmonary disease (COPD), cough, lactate dehydrogenase (LDH), creatine kinase (CK), white blood count (WBC), body temperature, and heart rate were identified to be included in the model. The specificity, sensitivity, and accuracy of the full model were 100%, 85.7%, and 87.5% respectively. The calibration curve also showed good agreement between the predicted and observed values in the model.Conclusions: The nomogram can predict the in-hospital incidence of ARDS in COVID-19 patients. It helps physicians to make an individualized treatment plan for each patient.
Subject(s)
Pulmonary Embolism , Pulmonary Disease, Chronic Obstructive , Respiratory Distress Syndrome , Cough , Hypertension , COVID-19ABSTRACT
BackgroundInformation regarding the impact of cardiovascular disease (CVD) on disease progression among patients with mild coronavirus disease 2019 (COVID-19) is limited. MethodsThis study evaluated the association of underlying CVD with disease progression in patients with mild COVID-19. The primary outcome was the need to be transferred to intensive care due to disease progression. The patients were divided with and without CVD as well as stable and intensive care groups. ResultsOf 332 patients with mild COVID-19, median age was 51 years (IQR, 40-59 years), and 200 (61.2%) were female. Of 48 (14.5%) patients with CVD, 23 (47.9%) progressed to severe disease status and required intensive care. Compared with patients without CVD, patients with CVD were older, and more likely to have fatigue, chest tightness, and myalgia. The rate of requiring intensive care was significantly higher among patients with CVD than in patients without CVD (47.92% vs. 12.4%; P<0.001). In subgroup analysis, rate of requiring intensive care was also higher among patients with either hypertension or coronary heart disease than in patients without hypertension or coronary heart disease. The multivariable regression model showed CVD served as an independent risk factor for intensive care (Odd ratio [OR], 2.652 [95% CI, 1.019-6.899]) after adjustment for various cofounders. ConclusionsPatients with mild COVID-19 complicating CVD in are susceptible to develop severe disease status and requirement for intensive care. Key PointsO_ST_ABSQuestionC_ST_ABSWhat is the impact of coexisting cardiovascular diseases (CVD) on disease progression in patients with mild COVID-19? FindingsAlthough most patients with mild COVID-19 were discharged alive from hospital, approximately 47.9% patients with coexisting CVD developed severe disease status and required intensive care. CVD is an independent risk factor of intensive care among patients with mild COVID-19. MeaningCoexisting CVD is associated with unfavorable outcomes among patients with mild COVID-19. Special monitoring is required for these patients to improve their outcome.
Subject(s)
COVID-19ABSTRACT
Objective@#To identify the characteristics including clinical features and pulmonary computed tomography (CT) features of heart failure and novel coronavirus pneumonia(COVID-19).@*Methods@#This study was a retrospective study. A total of 7 patients with Heart failure and 12 patients with COVID-19 in the Second Xiangya Hospital of Central South University between December 1, 2019 and February 15, 2020 were enrolled. The baseline clinical and imaging features of the two groups were statistically analyzed.@*Results@#There was no significant difference in age and sex between the two groups, but the incidence of epidemiological contact history, fever or respiratory symptoms in the COVID-19 group was significantly higher than that in the heart failure group (12/12 vs. 2/7, P=0.001; 12/12 vs. 4/7, P<0.001). While the proportion of cardiovascular diseases and impaired cardiac function was significantly less than that of the heart failure group(2/12 vs.7/7, P<0.001; 0/12 vs.7/7, P<0.001). For imaging features, both groups had ground-glass opacity and thickening of interlobular septum, but the ratio of central and gradient distribution was higher in patients with heart failure than that in patients with COVID-19 (4/7 vs. 1/12, P=0.04). In heart failure group, the ratio of the expansion of small pulmonary veins was also higher (3/7 vs. 0, P=0.013), and the lung lesions can be significantly improved after effective anti-heart failure treatment. Besides, there are more disease with rounded morphology in COVID-19 (9/12 vs. 2/7, P=0.048) .@*Conclusions@#More patients with COVID-19 have epidemiological history and fever or respiratory symptoms. There are significant differences in chest CT features, such as enlargement of pulmonary veins, lesions distribution and morphology between heart failure and COVID-19.
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OBJECTIVES To compare chest CT findings in heart failure with those of Corona Virus Disease 2019 (COVID-19) pneumonia. BACKGROUND During epidemic period, chest computed tomography (CT) has been highly recommended for screening patients with suspected COVID-19. However, the comparison of CT imaging between heart failure and COVID-19 pneumonia has not been fully elucidated. METHODS Patients with heart failure (n=12), COVID-19 pneumonia (n=12) and one patient with both diseases were retrospectively enrolled. Clinical information and imaging of chest CT were collected and analyzed. RESULTS There was no difference of ground glass opacity (GGO), consolidation, crazy paving pattern, lobes affected and septal thickening between heart failure and COVID-19 pneumonia. However, less rounded morphology (8.3% vs. 67%, p=0.003), more peribronchovascular thickening (75% vs. 33%, p=0.041) and fissural thickening (33% vs. 0%, p=0.028), less peripheral distribution (33% vs. 92%, p=0.003) were found in heart failure group than that in COVID-19 group. Importantly, there were also more patients with upper pulmonary vein enlargement (75% vs. 8.3%, p=0.001), subpleural effusion and cardiac enlargement in heart failure group than that in COVID-19 group (50% vs. 0%, p=0.005, separately). Besides, more fibrous lesions were found in COVID-19 group although there was no statistical difference (25% vs. 0%, P=0.064) CONCLUSIONS Although there are some overlaps of CT imaging between heart failure and COVID-19, CT is still a useful tool in differentiating COVID-19 pneumonia.