Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China

Abstract

Background: During the outbreak of coronavirus disease 2019 (COVID-19), consistent and considerable differences in disease severity and mortality rate of patients treated in Hubei province compared to those in other parts of China have been observed. We sought to compare the clinical characteristics and outcomes of patients being treated inside and outside Hubei province, and explore the factors underlying these differences.

Methods: Collaborating with the National Health Commission, we established a retrospective cohort to study hospitalised COVID-19 cases in China. Clinical characteristics, the rate of severe events and deaths, and the time to critical illness (invasive ventilation or intensive care unit admission or death) were compared between patients within and outside Hubei. The impact of Wuhan-related exposure (a presumed key factor that drove the severe situation in Hubei, as Wuhan is the epicentre as well the administrative centre of Hubei province) and the duration between symptom onset and admission on prognosis were also determined.

Results: At the data cut-off (31 January 2020), 1590 cases from 575 hospitals in 31 provincial administrative regions were collected (core cohort). The overall rate of severe cases and mortality was 16.0% and 3.2%, respectively. Patients in Hubei (predominantly with Wuhan-related exposure, 597 (92.3%) out of 647) were older (mean age 49.7 versus 44.9 years), had more cases with comorbidity (32.9% versus 19.7%), higher symptomatic burden, abnormal radiologic manifestations and, especially, a longer waiting time between symptom onset and admission (5.7 versus 4.5 days) compared with patients outside Hubei. Patients in Hubei (severe event rate 23.0% versus 11.1%, death rate 7.3% versus 0.3%, HR (95% CI) for critical illness 1.59 (1.05-2.41)) have a poorer prognosis compared with patients outside Hubei after adjusting for age and comorbidity. However, among patients outside Hubei, the duration from symptom onset to hospitalisation (mean 4.4 versus 4.7 days) and prognosis (HR (95%) 0.84 (0.40-1.80)) were similar between patients with or without Wuhan-related exposure. In the overall population, the waiting time, but neither treated in Hubei nor Wuhan-related exposure, remained an independent prognostic factor (HR (95%) 1.05 (1.01-1.08)).

Conclusion: There were more severe cases and poorer outcomes for COVID-19 patients treated in Hubei, which might be attributed to the prolonged duration of symptom onset to hospitalisation in the epicentre. Future studies to determine the reason for delaying hospitalisation are warranted.

Conflict of interest statement

Conflict of interest: Wen-hua Liang has nothing to disclose. Conflict of interest: Wei-jie Guan has nothing to disclose. Conflict of interest: Cai-chen Li has nothing to disclose. Conflict of interest: Yi-min Li has nothing to disclose. Conflict of interest: Heng-rui Liang has nothing to disclose. Conflict of interest: Yi Zhao has nothing to disclose. Conflict of interest: Xiao-qing Liu has nothing to disclose. Conflict of interest: Ling Sang has nothing to disclose. Conflict of interest: Ru-chong Chen has nothing to disclose. Conflict of interest: Chun-li Tang has nothing to disclose. Conflict of interest: Tao Wang has nothing to disclose. Conflict of interest: Wei Wang has nothing to disclose. Conflict of interest: Qi-hua He has nothing to disclose. Conflict of interest: Zi-sheng Chen has nothing to disclose. Conflict of interest: Sook-San Wong has nothing to disclose. Conflict of interest: Mark Zanin has nothing to disclose. Conflict of interest: Jun Liu has nothing to disclose. Conflict of interest: Xin Xu has nothing to disclose. Conflict of interest: Jun Huang has nothing to disclose. Conflict of interest: Jian-fu Li has nothing to disclose. Conflict of interest: Li-min Ou has nothing to disclose. Conflict of interest: Bo Cheng has nothing to disclose. Conflict of interest: Shan Xiong has nothing to disclose. Conflict of interest: Zhan-hong Xie has nothing to disclose. Conflict of interest: Zheng-yi Ni has nothing to disclose. Conflict of interest: Yu Hu has nothing to disclose. Conflict of interest: Lei Liu has nothing to disclose. Conflict of interest: Hong Shan has nothing to disclose. Conflict of interest: Chun-liang Lei has nothing to disclose. Conflict of interest: Yi-xiang Peng has nothing to disclose. Conflict of interest: Li Wei has nothing to disclose. Conflict of interest: Yong Liu has nothing to disclose. Conflict of interest: Ya-hua Hu has nothing to disclose. Conflict of interest: Peng has nothing to disclose. Conflict of interest: Jian-ming Wang has nothing to disclose. Conflict of interest: Ji-yang Liu has nothing to disclose. Conflict of interest: Zhong Chen has nothing to disclose. Conflict of interest: Gang Li has nothing to disclose. Conflict of interest: Zhi-jian Zheng has nothing to disclose. Conflict of interest: Shao-qin Qiu has nothing to disclose. Conflict of interest: Jie Luo has nothing to disclose. Conflict of interest: Chang-jiang Ye has nothing to disclose. Conflict of interest: Shao-yong Zhu has nothing to disclose. Conflict of interest: Lin-ling Cheng has nothing to disclose. Conflict of interest: Feng Ye has nothing to disclose. Conflict of interest: Shi-yue Li has nothing to disclose. Conflict of interest: Jin-ping Zheng has nothing to disclose. Conflict of interest: Nuo-fu Zhang has nothing to disclose. Conflict of interest: Nan-shan Zhong has nothing to disclose. Conflict of interest: Jian-xing He has nothing to disclose.

Copyright ©ERS 2020.

Figures

FIGURE 1

Incidence of severe cases and deaths in China, in the Hubei province and outside Hubei as of 31 January 2020. The severe events and death were reported by different statistical sources which presented a slight difference in total number. Data are presented as n/N, unless otherwise stated.

FIGURE 2

The official statistics of all documented laboratory confirmed cases throughout China according to the National Health Commission (as of 31 January 2020). Data are presented as n/N, where n is the number of patients being included in the final data analysis for each province/autonomous region/provincial municipalities, while N is the number of laboratory confirmed cases for each province/autonomous region/provincial municipalities as reported by the National Health Commission.

FIGURE 3

Incidence of severe cases and deaths, in Hubei patients, in non-Hubei patients, in Wuhan contacts and in non-Wuhan contacts. Data are presented as n/N, unless otherwise stated.

FIGURE 4

a) The time-dependent risk of reaching critical illness between patients inside and outside the Hubei province. b) The time-dependent risk of reaching critical illness between patients with and without Wuhan-related exposure. c) The time-dependent risk of reaching critical illness among patients in the Hubei province who had Wuhan-related exposure, patients outside the Hubei province who had Wuhan-related exposure, and patients outside the Hubei province who did not have a Wuhan-related exposure. d) The time-dependent risk of reaching critical illness between patients treated outside Hubei with and without Wuhan-related exposure.