Reported by: Luo Yun

Translated by: Wu Xia

On February 7, the Journal of the American Medical Association (JAMA) published an article on "Clinical Features of Patients with Pneumonia Infected by a New Coronavirus" online, with a research paper entitled "Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China".

The thesis was completed by Peng Zhiyong, director of the Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, with the support of Dean Wang Xinghuan, in collaboration with the Department of Infectious Diseases and the Department of Emergency Medicine. The paper also refreshed the record of clinical research articles published by Wuhan University Clinical College in top international medical journals

Describe the clinical features of the new coronavirus pneumonia from a large number of cases for the first time.

The new coronavirus pneumonia is an acute infectious pneumonia. The pathogen is a new coronavirus previously not found in humans, namely the 2019 novel coronavirus (2019-nCoV). The case first appeared in Wuhan, Hubei Province in December 2019. With the spread of the epidemic, other cases in China and abroad have also occurred. On January 30, 2020, the WHO announced that the new coronavirus pneumonia epidemic was listed as a public health emergency of concern (PHEIC). On February 7, 2020, the National Health Commission decided to temporarily name "new coronavirus-infected pneumonia" as "new coronavirus pneumonia", referred to as "new coronary pneumonia", and the English name "Novel Coronavirus Pneumonia", referred to as "NCP" . As of February 9, 2020, a total of 37,280 NCP cases have been diagnosed nationwide, and 24 countries worldwide have reported the cases.

Zhongnan Hospital of Wuhan University started to treat new coronavirus pneumonia as early as the beginning of the outbreak, that is, early January. On January 8, a patient with new type of coronavirus pneumonia was unable to maintain conventional respiratory support treatment due to dyspnea and severe hypoxemia. He was transferred to ICU for advanced respiratory support and received ECMO treatment. As of February 9, 56 critically ill patients have been treated in the ICU.

A new type of coronavirus (2019-nCov) infection caused the outbreak, and its clinical manifestations and treatments have their own characteristics. Earlier published articles focused on revealing the mode of transmission and epidemiology of the disease. This paper by Professor Peng Zhiyong is by fa covering the largest number of cases of new coronary pneumonia, and for the first time comprehensively summarizes the patient's course characteristics, clinical manifestations, treatment effects, differences between severe patients and non-severe patients, and prognosis.

In the study of clinical test indicators, the results of 5 dead patients and 28 surviving patients were compared. The indicators include white blood cells, neutrophil counts, lymphocyte counts, D-dimer, blood urea nitrogen and blood creatinine Value. The results showed that during the hospitalization, most patients experienced a decline in lymphocyte counts, but this situation was more severe throughout the death process. Neutrophils and leukocytes have higher overall values among dead patients. At the same time, with the progress and deterioration of the disease, the death of patients with blood urea nitrogen and creatinine will rise rapidly in the later stage of the disease. In response to these data, the team of Professor Peng Zhiyong speculated on the cause of death during the discussion-neutrophil disease may be related to the cytokine storm caused by virus invasion; coagulation activation may be related to persistent inflammatory response; acute kidney injury may be related to Hypoxia is related to the direct effects of shock. The above three pathways may be synergistic factors leading to death.

Patients with atypical symptoms may become a potential source of transmission of the virus

The article also focuses on the clinical characteristics of critically ill patients. Early symptoms of the disease are mostly fever, dry cough, muscle pain, fatigue, dyspnea, and hypoxemia. Less common symptoms are headache, dizziness, abdominal pain, diarrhea, nausea and vomiting. One quarter of patients had abdominal symptoms such as diarrhea and vomiting 1-2 days before the onset of fever and dyspnea. The disease can spread rapidly in the population at an early stage. In addition to the highly infectious nature of the virus, the presence of atypical symptoms makes patients spread the virus silently.

The presence of atypical symptoms is a serious finding, especially abdominal symptoms, suggesting that the fecal-oral route may be one of the routes of transmission of the disease. Studies have confirmed that the virus is detected in the stools of patients with neo-coronary pneumonia with abdominal symptoms. On the other hand, it also suggested that the protection of new coronary pneumonia couldn’t be limited to patients with symptoms or typical symptoms. The majority of medical workers and the public should strengthen isolation and protection at any time to reduce cross-infection.

It is worth mentioning that Director Peng Zhiyong determined that NCP was a severe infectious disease in the early stage of the epidemic and adopted strict isolation and protection measures in the department. Therefore, only 2 of the 40 infected medical workers are ICU staff member.

Significant treatment effect, the prognosis of critically ill patients is better than other medical units of the same level

In terms of prognosis, 36 of the 138 patients who were transferred to the ICU were critically ill, and the critical rate was 26%. Six of the 36 people eventually died, with an ICU mortality rate of 16.7% and an overall mortality rate of 4.3%. Of the surviving patients who entered the ICU, 9 were discharged home and 10 were transferred out of the ICU after their illness was stable, and 11 were still in the ICU. Compared with the data on the Internet as of January 27, both the overall mortality rate and ICU mortality rate of Zhongnan Hospital are relatively low. Once the article was published, it aroused great interest from various medical units. Everyone called Professor Peng Zhiyong to learn about the hospital's experience in the diagnosis and treatment of NCP.

Article Link:：https://jamanetwork.com/journals/jama/fullarticle/2761044