dziakj1
commented
4 years ago Summary
Suggested questions to answer about each paper:
- What did they analyze?
Medical records of 1099 hospitalized patients with lab-confirmed Covid-19 infections in China, whose infections were reported to National Health Commission between December 11, 2019, and January 31, 2020. From 552 hospitals in 30 regions. The sample comprised 14.2% of the 7736 Covid-19 cases hospitalized as of January 29, 2020. Researchers reviewed radiological assessments and lab results. 43.9% of the patients lived in Wuhan; among non-Wuhan residents, 72.3% had visited there or had had contact with Wuhan residents. 41.9% of the patients were female. The median age was 47 years; the interquartile range was 35 to 58, with only 0.9% under 15. 261 of the patients had some coexisting disorder, including 165 cases of hypertension. Most of the patients received intravenous antibiotics, and some received various other treatments (p. 1716). The authors also say they classified cases as severe (926 patients) or nonsevere (173 patients) based on American Thoracic Society guidelines.
- What methods did they use?
Only descriptive statistics (proportions, medians, interquartile ranges)
- Does this paper study COVID-19, SARS-CoV-2, or a related disease and/or virus?
Yes, all patients had confirmed SARS-CoV-2 infection.
- What is the main finding (or a few main takeaways)?
Incubation period: For 291 patients for whom a specific date of exposure could be identified, incubation periods were calculated. "The incubation period was defined as the interval between the potential earliest date of contact of the transmission source (wildlife or person with suspected or confirmed case) and the potential earliest date of symptom onset (i.e., cough, fever, fatigue, or myalgia)." (p. 1710). The median incubation period was 4 days, with an interquartile range of 2 to 7.
Diverse symptom profiles: A key finding was that "Patients often presented without fever, and many did not have abnormal radiologic findings" (p. 1708). In particular, "Fever was present in 43.8% of the patients on admission but developed in 88.7% during hospitalization. The second most common symptom was cough (67.8%); nausea or vomiting (5.0%) and diarrhea (3.8%) were uncommon" (p. 1710).
Radiologic findings: For 975 of the patients, CT scans were performed on admission; 86.2% of these showed abnormal results. "The most common patterns on chest CT were ground-glass opacity (56.4%) and bilateral patchy shadowing (51.8%)... No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease."
Laboratory findings: 83.2% had lymphocytopenia on admission, 36.2% had thrombocytopenia and 33.7% had leukopenia. "Most of the patients had elevated levels of C-reactive protein; less common were elevated levels of alanine aminotransferase, aspartate aminotransferase, creatine kinase, and D-dimer." Abnormalities were stronger on average in severe vs. in nonsevere disease.
Endpoints: Primary outcome of interest was a composite endpoint consisting of ICU admission, mechanical ventilation use, or death. Secondary outcomes of interest included rate of death, and time from symptom onset until composite end point or its components. "A primary composite end-point event occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died (Table 3). Among the 173 patients with severe disease, a primary composite end-point event occurred in 43 patients (24.9%)." (p. 1717).
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What does this paper tell us about the background and/or diagnostics/therapeutics for COVID-19 / SARS-CoV-2? I guess the biggest takeaway -- although this is common knowledge by now -- was how diverse the symptoms were (e.g., not everyone even had a fever).
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Do you have any concerns about methodology or the interpretation of these results beyond this analysis?
The authors note " No imputation was made for missing data. Because the cohort of patients in our study was not derived from ran-dom selection, all statistics are deemed to be descriptive only" (p. 1710). They also point out that they only considered hospitalized patients; the true fatality rate was probably lower because people who did not become noticeably ill would not have sought medical attention.
Any comments or notes?
This was a medRxiv preprint (https://doi.org/ggkj9s) before being published in NEJM. It was one of the unreviewed preprints in rdvelasquez's issue #227.
agitter
rando2
Title: Please edit the title to add the name of the paper after the colon.
General Information
Please paste a link to the paper or a citation here:
Link: https://www.nejm.org/doi/10.1056/NEJMoa2002032
The preprint was at https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1.
What is the paper's Manubot-style citation?
Citation: @doi:10.1056/NEJMoa2002032
Is this paper primarily relevant to Background or Pathogenesis?
Please list some keywords (3-10) that help identify the relevance of this paper to COVID-19
Which areas of expertise are particularly relevant to the paper?