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Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China.
Eur Respir J. 2020 06; 55(6)ER

Abstract

BACKGROUND

During the outbreak of coronavirus disease 2019 (COVID-19), consistent and considerable differences in disease severity and mortality rate of patients treated in Hubei province compared to those in other parts of China have been observed. We sought to compare the clinical characteristics and outcomes of patients being treated inside and outside Hubei province, and explore the factors underlying these differences.

METHODS

Collaborating with the National Health Commission, we established a retrospective cohort to study hospitalised COVID-19 cases in China. Clinical characteristics, the rate of severe events and deaths, and the time to critical illness (invasive ventilation or intensive care unit admission or death) were compared between patients within and outside Hubei. The impact of Wuhan-related exposure (a presumed key factor that drove the severe situation in Hubei, as Wuhan is the epicentre as well the administrative centre of Hubei province) and the duration between symptom onset and admission on prognosis were also determined.

RESULTS

At the data cut-off (31 January 2020), 1590 cases from 575 hospitals in 31 provincial administrative regions were collected (core cohort). The overall rate of severe cases and mortality was 16.0% and 3.2%, respectively. Patients in Hubei (predominantly with Wuhan-related exposure, 597 (92.3%) out of 647) were older (mean age 49.7 versus 44.9 years), had more cases with comorbidity (32.9% versus 19.7%), higher symptomatic burden, abnormal radiologic manifestations and, especially, a longer waiting time between symptom onset and admission (5.7 versus 4.5 days) compared with patients outside Hubei. Patients in Hubei (severe event rate 23.0% versus 11.1%, death rate 7.3% versus 0.3%, HR (95% CI) for critical illness 1.59 (1.05-2.41)) have a poorer prognosis compared with patients outside Hubei after adjusting for age and comorbidity. However, among patients outside Hubei, the duration from symptom onset to hospitalisation (mean 4.4 versus 4.7 days) and prognosis (HR (95%) 0.84 (0.40-1.80)) were similar between patients with or without Wuhan-related exposure. In the overall population, the waiting time, but neither treated in Hubei nor Wuhan-related exposure, remained an independent prognostic factor (HR (95%) 1.05 (1.01-1.08)).

CONCLUSION

There were more severe cases and poorer outcomes for COVID-19 patients treated in Hubei, which might be attributed to the prolonged duration of symptom onset to hospitalisation in the epicentre. Future studies to determine the reason for delaying hospitalisation are warranted.

Authors+Show Affiliations

China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. These authors are joint first authors.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. These authors are joint first authors.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. These authors are joint first authors.Dept of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. These authors are joint first authors.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. These authors are joint first authors.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. These authors are joint first authors.Dept of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.Dept of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. Wuhan Jin-yin tan Hospital, Wuhan, China.Dept of Respiratory Disease, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.Dept of Respiratory Disease, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.Dept of Respiratory Disease, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.School of Public Health, The University of Hong Kong, Hong Kong SAR, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.Dept of Respiratory Disease, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.Wuhan Jin-yin tan Hospital, Wuhan, China.Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Shenzhen Third People's Hospital, Shenzhen, China. The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China.The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.The Central Hospital of Wuhan, Wuhan, China.Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China.Chengdu Public Health Clinical Medical Center, Chengdu, China.Huangshi Central Hospital of Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China.Wuhan Pulmonary Hospital, Wuhan, China.Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China.The First Hospital of Changsha, Changsha, China.The Third People's Hospital of Hainan Province, Sanya, China.Huanggang Central Hospital, Huanggang, China.Wenling First People's Hospital, Wenling, China.The Third People's Hospital of Yichang, Yichang, China.Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan, China.Xiantao First People's Hospital, Xiantao, China.The People's Hospital of Huangpi District, Wuhan, China.Dept of Respiratory Disease, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.Dept of Respiratory Disease, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.Dept of Respiratory Disease, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Dept of Respiratory Disease, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.Dept of Respiratory Disease, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. Both authors are joint principal authors.China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China drjianxing.he@gmail.com. Both authors are joint principal authors.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32269086

Citation

Liang, Wen-Hua, et al. "Clinical Characteristics and Outcomes of Hospitalised Patients With COVID-19 Treated in Hubei (epicentre) and Outside Hubei (non-epicentre): a Nationwide Analysis of China." The European Respiratory Journal, vol. 55, no. 6, 2020.
Liang WH, Guan WJ, Li CC, et al. Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China. Eur Respir J. 2020;55(6).
Liang, W. H., Guan, W. J., Li, C. C., Li, Y. M., Liang, H. R., Zhao, Y., Liu, X. Q., Sang, L., Chen, R. C., Tang, C. L., Wang, T., Wang, W., He, Q. H., Chen, Z. S., Wong, S. S., Zanin, M., Liu, J., Xu, X., Huang, J., ... He, J. X. (2020). Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China. The European Respiratory Journal, 55(6). https://doi.org/10.1183/13993003.00562-2020
Liang WH, et al. Clinical Characteristics and Outcomes of Hospitalised Patients With COVID-19 Treated in Hubei (epicentre) and Outside Hubei (non-epicentre): a Nationwide Analysis of China. Eur Respir J. 2020;55(6) PubMed PMID: 32269086.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China. AU - Liang,Wen-Hua, AU - Guan,Wei-Jie, AU - Li,Cai-Chen, AU - Li,Yi-Min, AU - Liang,Heng-Rui, AU - Zhao,Yi, AU - Liu,Xiao-Qing, AU - Sang,Ling, AU - Chen,Ru-Chong, AU - Tang,Chun-Li, AU - Wang,Tao, AU - Wang,Wei, AU - He,Qi-Hua, AU - Chen,Zi-Sheng, AU - Wong,Sook-San, AU - Zanin,Mark, AU - Liu,Jun, AU - Xu,Xin, AU - Huang,Jun, AU - Li,Jian-Fu, AU - Ou,Li-Min, AU - Cheng,Bo, AU - Xiong,Shan, AU - Xie,Zhan-Hong, AU - Ni,Zheng-Yi, AU - Hu,Yu, AU - Liu,Lei, AU - Shan,Hong, AU - Lei,Chun-Liang, AU - Peng,Yi-Xiang, AU - Wei,Li, AU - Liu,Yong, AU - Hu,Ya-Hua, AU - Peng,Peng, AU - Wang,Jian-Ming, AU - Liu,Ji-Yang, AU - Chen,Zhong, AU - Li,Gang, AU - Zheng,Zhi-Jian, AU - Qiu,Shao-Qin, AU - Luo,Jie, AU - Ye,Chang-Jiang, AU - Zhu,Shao-Yong, AU - Cheng,Lin-Ling, AU - Ye,Feng, AU - Li,Shi-Yue, AU - Zheng,Jin-Ping, AU - Zhang,Nuo-Fu, AU - Zhong,Nan-Shan, AU - He,Jian-Xing, Y1 - 2020/06/04/ PY - 2020/03/05/received PY - 2020/03/29/accepted PY - 2020/4/10/pubmed PY - 2020/6/13/medline PY - 2020/4/10/entrez JF - The European respiratory journal JO - Eur Respir J VL - 55 IS - 6 N2 - BACKGROUND: During the outbreak of coronavirus disease 2019 (COVID-19), consistent and considerable differences in disease severity and mortality rate of patients treated in Hubei province compared to those in other parts of China have been observed. We sought to compare the clinical characteristics and outcomes of patients being treated inside and outside Hubei province, and explore the factors underlying these differences. METHODS: Collaborating with the National Health Commission, we established a retrospective cohort to study hospitalised COVID-19 cases in China. Clinical characteristics, the rate of severe events and deaths, and the time to critical illness (invasive ventilation or intensive care unit admission or death) were compared between patients within and outside Hubei. The impact of Wuhan-related exposure (a presumed key factor that drove the severe situation in Hubei, as Wuhan is the epicentre as well the administrative centre of Hubei province) and the duration between symptom onset and admission on prognosis were also determined. RESULTS: At the data cut-off (31 January 2020), 1590 cases from 575 hospitals in 31 provincial administrative regions were collected (core cohort). The overall rate of severe cases and mortality was 16.0% and 3.2%, respectively. Patients in Hubei (predominantly with Wuhan-related exposure, 597 (92.3%) out of 647) were older (mean age 49.7 versus 44.9 years), had more cases with comorbidity (32.9% versus 19.7%), higher symptomatic burden, abnormal radiologic manifestations and, especially, a longer waiting time between symptom onset and admission (5.7 versus 4.5 days) compared with patients outside Hubei. Patients in Hubei (severe event rate 23.0% versus 11.1%, death rate 7.3% versus 0.3%, HR (95% CI) for critical illness 1.59 (1.05-2.41)) have a poorer prognosis compared with patients outside Hubei after adjusting for age and comorbidity. However, among patients outside Hubei, the duration from symptom onset to hospitalisation (mean 4.4 versus 4.7 days) and prognosis (HR (95%) 0.84 (0.40-1.80)) were similar between patients with or without Wuhan-related exposure. In the overall population, the waiting time, but neither treated in Hubei nor Wuhan-related exposure, remained an independent prognostic factor (HR (95%) 1.05 (1.01-1.08)). CONCLUSION: There were more severe cases and poorer outcomes for COVID-19 patients treated in Hubei, which might be attributed to the prolonged duration of symptom onset to hospitalisation in the epicentre. Future studies to determine the reason for delaying hospitalisation are warranted. SN - 1399-3003 UR - https://www.unboundmedicine.com/medline/citation/32269086/Clinical_characteristics_and_outcomes_of_hospitalised_patients_with_COVID_19_treated_in_Hubei__epicentre__and_outside_Hubei__non_epicentre_:_a_nationwide_analysis_of_China_ L2 - http://erj.ersjournals.com/cgi/pmidlookup?view=long&pmid=32269086 DB - PRIME DP - Unbound Medicine ER -