Author:
Wang Gang, ,Luo Feng Ming,Liu Dan,Liu Jia Sheng,Wang Ye,Chen Hong,Tian Pan Wen,Fan Tao,Tang Li,Yu He,Wang Lan,Feng Mei,Ni Zhong,Wang Bo,Song Zhi Fang,Wu Xiao Ling,Wang Hong Jun,Tong Xiang,Xue Miao,Lei Xian Ying,Long Bo,Jia Chao,Xiao Jun,Shang Juan,Xiong Nian,Luo Jian Fei,Liang Zong An,Li Wei Min
Abstract
AbstractBackgroundThere is limited information on the difference in epidemiology, clinical characteristics and outcomes of the initial outbreak of the coronavirus disease (COVID-19) in Wuhan (the epicenter) and Sichuan (the peripheral area) in the early phase of the COVID-19 pandemic. This study was conducted to investigate the differences in the epidemiological and clinical characteristics of patients with COVID-19 between the epicenter and peripheral areas of pandemic and thereby generate information that would be potentially helpful in formulating clinical practice recommendations to tackle the COVID-19 pandemic.MethodsThe Sichuan & Wuhan Collaboration Research Group for COVID-19 established two retrospective cohorts that separately reflect the epicenter and peripheral area during the early pandemic. The epidemiology, clinical characteristics and outcomes of patients in the two groups were compared. Multivariate regression analyses were used to estimate the adjusted odds ratios (aOR) with regard to the outcomes.ResultsThe Wuhan (epicenter) cohort included 710 randomly selected patients, and the peripheral (Sichuan) cohort included 474 consecutive patients. A higher proportion of patients from the periphery had upper airway symptoms, whereas a lower proportion of patients in the epicenter had lower airway symptoms and comorbidities. Patients in the epicenter had a higher risk of death (aOR=7.64), intensive care unit (ICU) admission (aOR=1.66), delayed time from illness onset to hospital and ICU admission (aOR=6.29 and aOR=8.03, respectively), and prolonged duration of viral shedding (aOR=1.64).ConclusionsThe worse outcomes in the epicenter could be explained by the prolonged time from illness onset to hospital and ICU admission. This could potentially have been associated with elevated systemic inflammation secondary to organ dysfunction and prolonged duration of virus shedding independent of age and comorbidities. Thus, early supportive care could achieve better clinical outcomes.
Funder
Sichuan Provincial Program for Diagnostic and Treatment of Covid-19
National Key Development Plan for Precision Medicine Research
National Natural Science Foundation of China
Publisher
Springer Science and Business Media LLC
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