A Retrospective Study of the Clinical Diagnosis and Treatment of 158 Cases of COVID-19

Xiangqi Chen¹Suyun Zhang¹Qunying Lin²Xibin Zhuang³Xiangyang Yao⁴Li Lin Li Lin⁵Xiaoyun Chen¹Guoxiang Lai⁶Baosong Xie^7*

• ¹Fujian Medical University Union Hospital, Fuzhou, China
• ²Affiliated Hospital of Putian University, Putian, China
• ³The First Hospital of Quanzhou Afliated to Fujian Medical University, Quanzhou, China
• ⁴First Affiliated Hospital of Xiamen University, Xiamen, China
• ⁵Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
• ⁶900th Hospital of the Joint Logistics Support Force, Fuzhou, China
• ⁷Fujian Provincial Hospital, Fuzhou, China

Objective: To summarize the clinical characteristics, management, and outcomes, and identify independent risk factors associated with the severity of coronavirus disease 2019 (COVID-19) patients from early-pandemic Fujian, China. Methods: A total of 158 patients with COVID-19 were recruited from 10 designed hospitals of the Fujian province between January 22 and February 26, 2020. Their clinical data were collected and summarized from electronic medical records. Potential independent risk factors associated with COVID-19 severity were explored.. Results: Of the 158 patients, 36 had mild, 106 had moderate, 8 had severe, and 8 had critical disease severity. The median age was 45 years (interquartile range 35-55) and 81 (51.3%) were men. 8.2% had a history of smoking. 31.6% had chronic underlying conditions, among which hypertension (13.9%), diabetes (7.6%), and liver disease (7.0%) were the most common. The most common initial symptom was fever, followed by cough, sputum and expectoration. 94.3% of patients had abnormal imaging findings on chest computed tomography or X-ray. Patients with severe/critical disease had significantly more prominent laboratory abnormalities, including an abnormal lymphocyte count and abnormal levels of white blood cells, albumin, aspartate aminotransferase, creatine kinase, lactate dehydrogenase, and D-dimer than mild/moderate patients (all p < 0.05). Independent risk factors associated with severe/critical disease included age ≥60 years [Odds ratio (OR) = 19.9], WBC ≥10×109/L (OR = 47.5) and D-dimer > 0.5mg/L (OR = 5.0) (p < 0.05). All patients received antiviral drugs; 126 (79.7%) also received traditional Chinese medicine and 29 (18.4%) received glucocorticoids. As of April 2, 133 patients (84.2%) were cured and discharged, 1 individual died (overall mortality, 0.6%), and the remaining 24 (15.2%) remained hospitalized after data gathering was completed. Conclusion: COVID-19 patients from Fujian province during early pandemic presented mostly as mild/moderate cases with fever and cough as the initial symptoms. The detection of cellular immune function, coagulation function, myocardial damage, and liver function can help assess the severity of COVID-19. Specifically, the most important risk factors were older age, WBC elevation, and D-dimer elevation. Timely comprehensive treatment might be beneficial in controlling COVID-19.