TY - JOUR T1 - Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicenter) and outside Hubei (non-epicenter): A Nationwide Analysis of China JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.00562-2020 SP - 2000562 AU - Wen-hua Liang AU - Wei-jie Guan AU - Cai-chen Li AU - Yi-min Li AU - Heng-rui Liang AU - Yi Zhao AU - Xiao-qing Liu AU - Ling Sang AU - Ru-chong Chen AU - Chun-li Tang AU - Tao Wang AU - Wei Wang AU - Qi-hua He AU - Zi-sheng Chen AU - Sook-San Wong AU - Mark Zanin AU - Jun Liu AU - Xin Xu AU - Jun Huang AU - Jian-fu Li AU - Li-min Ou AU - Bo Cheng AU - Shan Xiong AU - Zhan-hong Xie AU - Zheng-yi Ni AU - Yu Hu AU - Lei Liu AU - Hong Shan AU - Chun-liang Lei AU - Yi-xiang Peng AU - Li Wei AU - Yong Liu AU - Ya-hua Hu AU - Peng Peng AU - Jian-ming Wang AU - Ji-yang Liu AU - Zhong Chen AU - Gang Li AU - Zhi-jian Zheng AU - Shao-qin Qiu AU - Jie Luo AU - Chang-jiang Ye AU - Shao-yong Zhu AU - Lin-ling Cheng AU - Feng Ye AU - Shi-yue Li AU - Jin-ping Zheng AU - Nuo-fu Zhang AU - Nan-shan Zhong AU - Jian-xing He Y1 - 2020/01/01 UR - http://erj.ersjournals.com/content/early/2020/04/01/13993003.00562-2020.abstract N2 - 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 has 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 in and outside of Hubei. The impact of Wuhan-related exposure (a presumed key factor that drove the severe situation in Hubei, as Wuhan is the epicenter as well the administrative center of Hubei province) and the duration between symptom onset and admission on prognosis were also determined.Results Upon data cut-off (Jan 31st, 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, 597/647, 92.3%) were older (mean: 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%, hazards ratio (HR) for critical illness 1.59, 95%CI 1.05–2.41] have a poorer prognosis compared with patients outside of Hubei after adjusting for age and comorbidity. However, among patients outside of Hubei, the duration from symptom onset to hospitalisation (mean: 4.4 versus 4.7 days) and prognosis (HR 0.84, 95%CI 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 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 epicenter. Future studies to determine the reason for delaying hospitalisation are warranted.This study highlights the necessity of urgent and vigorous support of healthcare resources and increased public awareness during the early stages of an outbreak of COVID-19 or similar diseases. ER -