Patient Predisposition at Hospital Admission Indirectly Dictates Disease Severity, Clinical Course and Outcomes of COVID-19 Pneumonia Patients in Wuhan, China

Background: The epidemic outbreak of SARS-CoV-2 infective pneumonia still remains a clinical challenge in China. A full understanding of the clinical characteristics of hospital admitted SARS-CoV-2 infected patients as well as adequate clinical approach to treatment outcomes of these patients are still lacking. Methods: A prospective analysis of 179 patients with COVID-19 pneumonia admitted to Wuhan Pulmonary Hospital from December 25th, 2019 to February 7th, 2020 were included in this study. At admission, all patients were trichotomized based on defined disease severity criteria: mild-to-moderate, severe, and critically-ill. The primary outcome measure was mortality incidence. Secondary outcomes included: rates of mechanical ventilation and intensive care unit (ICU) admission and major medical complications. Findings: Of the 179 patients, (79/179) were mild-to-moderate, (57/179) were severe and (43/179) were critically-ill patients, respectively. The median age of the entire patient cohort was 57·6 years [interquartile range (IQR: 49·0–68·0) years]. The median age was [53·0 (IQR 44·0–61·0) years] for mild-to-moderate, [57·0 (IQR 49·0–70·0) years] for severe and [68·0 (IQR 62·0–72·0) years] for critically-ill patients, respectively, (P<0·001). A positive association of disease severity was observed with the incidence of common symptoms and co-morbidities (P<0·05). Overall mortality incidence was 11·7% (95% confidence interval, 7·0%–16·5%). Of the critically-ill patients, 12/43 (27·9%), 19/43 (44·2%) and 4/43 (9·3%) received non-invasive MV, invasive MV, and ECMO, respectively. Of all patients admitted to ICU, [22/179 (10·4%)], approximately 51·0% (22/43) accounted for patients in the critically-ill subgroup. Major complications included ARDS in 74/179 (41·3%), followed by septic shock in 23/179 (12·8%) and AKI in 14/179 (7·8%). Interpretation: Our findings indicate that patient predisposing factors such as advanced age, underlying medical conditions and patients’ susceptibility to rapidly progress to ARDS status terminally determine clinical course, morbidity and mortality outcomes in SARS-CoV-2 infective pneumonia patients. Funding Statement: This work was supported by Beijing Municipal Administration of Hospitals’ Mission Plan (SML20150301), and 1351 Talents Program of Beijing Chao-Yang Hospital (WXZXZ-2017-01). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: Local research ethics boards (the Ethics Commission of Wuhan Pulmonary Hospital) approved the study (wufeilunli-2020-02) and waived the need for patients' written informed consent.