Patient characteristics
A total of 239 adult inpatients at Wuhan Tongji Hospital (Wuhan, China) who were diagnosed with COVID-19 according to to the Chinese management guideline for COVID-19 (version 7.0) and the World Health Organization interim guidance were included in this retrospective study. Five patients is excluded for death with positive pharyngeal swab test.(Figure1).In this patient population, the median age was 63.0 years old (IQR, 52.0, 72.0). Of the 239 patients, 50.2% (120/239) were male, 18.8% (45/239) of the patients progressed to critical illness (Table 1). Patients were considered progressing to critical illness if at least one of the following conditions were observed: 1. Respiratory failure requiring mechanical ventilation; 2. Shock; 3. Combined organ failure requiring monitoring and treatment in the intensive care unit (ICU).
Of the 239 patients, 13.8% (33/239) died during the first 28 days of hospitalization. The most common symptoms among the patients were fever 79.1% (189/239) and cough 79.9% (191/239). The most common reported comorbidity was hypertension 37.7% (90/239). For all patients in the retrospective study, the median viral RNA shedding duration time was 26 days (IQR, 20.0, 34.0). The median time from onset of symptoms to patient diagnosis with COVID-19 was 7 days (IQR,3.0, 13.0). The median time from onset of illness to inpatient admission at the hospital was 15 days (IQR,10.0, 21.0) and the median time from onset of illness to treatment with antiviral therapies was 5 days (IQR,1.0, 12.0).
Patients with prolonged viral RNA shedding duration (≥ 26 days) were younger (61.5 ys vs. 66.0 ys, P= 0.02), had a lower APACHE II score (5.0 vs. 6.0 , P < 0.01), a lower hs-CRP levels (3.6 mg/L vs. 8.9 mg/L, P= 0.03), and a higher lymphocyte count (1.4 ×109 /L vs.1.2×109 /L, P < 0.01). Patients with a long viral RNA shedding duration had a viral RNA shedding duration 1.7 times greater than patients with a short viral RNA shedding duration (34 days vs. 20 days, P < 0.01). Patients with a long viral RNA shedding duration also had a longer time from illness onset to diagnosis with COVID-19 (10 days vs. 4 days, P< 0.01), to hospital admission (7 days vs. 4 days,P < 0.01), and to antiviral treatment (19 daysvs. 10 days, P < 0.01).