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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Our take —

Fever and cough were the two most common symptoms of COVID-19 among this early group of patients in Wuhan, China. A high proportion of hospitalized patients died among those with observed outcomes, but many more remained in the hospital at the time of analysis, so results do not represent true mortality risks. Older patients had a higher risk of death, and underlying conditions were common among those hospitalized.

Study design

Case Series

Study population and setting

This study included 191 patients (≥18 years, median age 56 years, 62% male) with lab-confirmed SARS-CoV-2 infection admitted to two hospitals in Wuhan, China (representing all confirmed cases in Wuhan during the study period), who either died or were discharged alive between December 29, 2019 and January 31, 2020. Patient data, including laboratory findings and outcomes, were extracted from electronic medical records.

Summary of Main Findings

Among 813 suspected COVID-19 patients, 622 were excluded because they were still hospitalized by January 31, 2020, did not have a positive test for SARS-CoV-2, or had key missing data. Of the remaining 191 patients, 54 (28%) died, at a median time of 19 days from admission. 137 (72%) were discharged alive, at a median time of 22.0 days from admission. 31 of 32 patients in the study population who required mechanical ventilation died. Fever (94%) and cough (79%) were the most common symptoms at presentation. 91 (48%) patients had at least one underlying comorbidity: hypertension (30%), diabetes (19%), and coronary heart disease (8%) were the most common. In those discharged alive, the median duration of viral shedding was 20 days. In multivariable regression, older age, higher d-dimer concentrations at admission, and higher Sequential Organ Failure Assessment (SOFA) score were independently associated with increased risk of death.

Study Strengths

The study population was drawn from all confirmed COVID-19 cases in Wuhan, China at the beginning of the epidemic. Patient characteristics, symptoms, and progression were well characterized.

Limitations

Follow-up was incomplete for a large proportion of hospitalized COVID-19 patients, so the reported risk of mortality in the study population is unlikely to reflect the true fatality ratio (particularly among those requiring mechanical ventilation). The availability and timing of laboratory measurements varied and may not therefore be comparable. The overall number of patients included in the study was fairly small.

Value added

This study was one of the first case series to emerge from the early stage of the epidemic. At the time of publication, it called attention to the increased risks faced by older individuals and those with underlying health conditions, and helped to reinforce fever and cough as the two bellwether symptoms of COVID-19 at presentation. These findings have been replicated elsewhere and are now well understood.