Relationship between fever and early clinical diagnosis and treatment in mild COVID-2019 patients

• Main Author: Chu-Fen Lin
• Format: Article
• Language: English
• Published: Editorial Board of Journal of Hainan Medical University 2020-10-01
• Series: Journal of Hainan Medical University
• Subjects: covid-19; mild; early onset; clinical diagnosis and treatment; fever
• Online Access: http://www.hnykdxxb.com/PDF/202020/01.pdf

treatment and fever of 457mild cases of COVID-19. Methods: A tatal of 457cases of mild COVID- 19 diagnosed in Wuhan Jianghan module Hospital from February 6,2020 to February 26,2020 were gathered,and the cases with/without fever were retrospectively analyzed in epidemiology, clinical manifestation, blood routing, hypersensitive C-reactive protein (hs-CRP), pathogens serological testing, chest CT and drugs treatment. Results: For 312 fever cases, the average age was(47.6±10.9) years old, male was 128 cases(41%), the mean peak fever was 38(36.8,38.6)℃, fever lasting was 2(0,3)days, 131cases(28.7%) had Huanan seafood market exposure history, 90 cases(28.8%) had closely contact with COVID-19 patients, 20cases(6.4%) had hypertension history,10 cases（3.2%） had diabetes,5cases （1.6%）had coronary heart disease. Main symptoms of fever group including dry cough of 260cases(83.3%), of 104cases(33.3%) ,blood sputum of 9cases(2.9%), chest tightness 20cases(19.6%),shortness of breath of 87cases(27.9%), weak of 105cases(33.7%),diarrhea of 43cases(13.8%),sleep disorders of 61cases(19.6%), among fever cases with sputum and shortness of breath more rather without fever, and two groups were statistically significantly difference (P＜0.05). In fever group,WBC(109/L)[4.34 (3.69, 5.26) than 5.11 (4.22, 6.22), P < 0.001], NEUT (109 / L) [2.67 (2.1, 3.49) than 2.88 (2.37, 3.9), P < 0.05], LYM (109 / L) [0.9 (0.8, 1.1) than 1.36 (1.03, 1.85), P < 0.001), PLT (109 / L)/(106,188) 134-189 (132,224), P < 0.001) were lower than normal group, while WBC < 4.0 伊 109 / L [108 (34.6%) than 24 (16.6%), P < 0.001)], LYM < 1.0 伊 109 / L [189 (60.6%) than 31 (21.4%), P < 0.001)], PLT < 100 伊 109 / L [45 (14.4%) than in 2 (1.4%), P < 0.001) and hs - CRP (mg/L) [14 (6.83, 32) than 3.4 (0.96, 10.75), P < 0.001) were higher than normal group, and pathogens serological examination of 36cases shown influenza I/II virus IgM antibody positive in 3cases (8.3%), respiratory syncytial virus IgM antibody positive in 2 cases (5.6%), mycoplasma pneumoniae IgM antibody positive (11.1%), 4 cases of adenovirus IgM antibody positive (11.1%), but 4 pathogens of fever group and normal group were no statistical difference (P > 0.05). According to early onset of chest CT examination, there were no change of 11cases(2.4%), unilateral lung lesions of 93cases(20.4%), bilateral lung lesions of 353 cases(77.2%), ground glass shadow of 228 cases (73.1%), high density shadow patch of 65 cases (20.8%), consolidation shadow of 6 cases (1.9%), while fever group compared with normal group, there were no statistically significant difference (P > 0.05). Logistic regression analysis showed that LYM (OR = 0.24, 95% CI = 0.139 ~ 0.415, P < 0.001), LYM < 1.0 x 109 / L (OR = 5.12, 95% CI = 3.07 ~ 8.65, P < 0.001), PLT < 100 伊 109 / L (OR = 6.1, 95% CI = 1.36 ~ 27.33, P < 0.05), and the hs - CRP (OR = 1.03, 95% CI = 1.02 ~ 1.05, P < 0.001) were fever independent impact factors in mild COVID-19. Aiming at COVID-19 treatment, Chinese medicine usage had 416cases (91%),antiviral drugs had 328cases(71.8%),and antibiotics had 172cases(37.6%),furthermore, fever group using antiviral and antibiotic drugs was higher than normal group(P＜0.05),and compared to low fever group, high fever group used more antibiotic drugs(P＜0.05). Conclusions: Mild COVID-19 patients with early onset had epidemiological characteristics, and fever,dry cough,expectoration and shortness of breath were main symptoms, and chest CT often involved bilateral lung lesions,ground glass shadow and patch density shadow.The fever patients in WBC, LYM, PLT,hs- CRP index changed significantly and could affect on anti-infective therapy selection.