Characteristics and Associations with Severity in COVID-19 Patients: A Multicentre Cohort Study from Jiangsu Province, China

Background: COVID-19 has become a major health event that endangers public health throughout China and the world raising international concern. This study aims to assess characteristics and factors associated with severity in COVID-19 patients outside Hubei province. Method: In this retrospective multicentre cohort study, all 2019-nCoV cases diagnosed at 24 designated hospitals in Jiangsu province, between 10 January and 18 February 2020 were included. Data on epidemiological, clinical, laboratory, and radiological variables was collected. Patients were followed-up at 7 time points over 14 days from hospital admission to discharge. Primary outcome was the worst level of COVID-19 infection during 14 days follow-up as measured in 3 severity groups (asymptomatic or mild, moderate, and severe or critically ill). Findings: 620 patients included in the study consisted of 97 (15.6%) asymptomatic or mild, 470 (75.8%) moderate, and 53 (8.6%) severe or critically ill cases. Up to 18 February 2020, no patients had died and 252(40.6%) patients were discharged. All 53 severe or critically ill patients had respiratory failure. The mean SpO2 was consistently lower but respiratory rate was consistently higher over 14 days in the severe or critically ill group compared with the asymptomatic/mild and moderate groups. Multinomial logistic regression analysis identified the following factors associated with severe or critically ill infection as compared to asymptomatic or mild infection: age (odds ratio [OR] 1.11, 95%CI 1.07-1.14), fever (OR 11.54, 95%CI 3.98-33.50), cough (OR 3.88, 95%CI 1.38-10.88), and other initial symptoms (OR 3.49, 95%CI 1.35-9.03), and SpO2 at admission (OR 0.66, 95%CI 0.50-0.88). Interpretation: The COVID-19 patient’s clinical outcome in Jiangsu was no worse than that in Hubei. Age, fever, cough and SpO2 were found to be associated with a severe or critically ill infection. These results may help screening and early management of the COVID-19 cases. Funding Statement: The authors stated: "None." Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The Ethics Committee of Zhongda Hospital Affiliated to Southeast University approved this study (2020ZDSYLL013–P01 and 2020ZDSYLL019–P01). Informed consents were waived due to the public health emergency and the retrospective observational study design requiring no intervention and posing no impact on the diagnosis and treatment of patients.