Assessing risk factors for SARS-CoV-2 infection in patients presenting with symptoms in Shanghai, China: a multicentre, observational cohort study

doi:10.1016/S2589-7500(20)30109-6

Observational Study

. 2020 Jun;2(6):e323-e330.

doi: 10.1016/S2589-7500(20)30109-6. Epub 2020 May 14.

Assessing risk factors for SARS-CoV-2 infection in patients presenting with symptoms in Shanghai, China: a multicentre, observational cohort study

Bei Mao¹, Yang Liu¹, Yan-Hua Chai¹, Xiao-Yan Jin², Hai-Wen Lu¹, Jia-Wei Yang¹, Xi-Wen Gao³, Xiao-Lian Song⁴, Hong Bao⁵, An Wang⁶, Wen-Chao Gu⁷, Lei Zhao⁸, Jie-Ping Pan⁹, Fan Li¹⁰, Tie-Feng Zhang¹¹, Ye-Chang Qian¹², Chun-Ling Du¹³, Wei Ding¹⁴, Chun-Lin Tu¹⁵, De-Jie Chu¹⁶, Chun Li¹⁷, Ling Ye¹⁷, Yong Luo¹⁸, Cui-Xia Zheng¹⁹, Rong-Huan Yu²⁰, Zhong-Min Qiu²¹, Hui-Fang Cao²², Jia-Wei Ren²³, Jing-Ya Zhao²⁴, Chang-Hui Wang⁴, Hong-Zhou Lu²⁵, Jun Li²⁶, Yang Hu¹, Shuo Liang¹, Zhi-Jun Jie²⁷, Jie-Ming Qu²⁴, Jin-Fu Xu¹

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Pulmonary and Critical Care Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Department of Respiratory and Critical Care Medicine, Minhang Hospital, Fudan University, Shanghai, China.
⁴ Department of Respiratory and Critical Medicine, Shanghai Tenth People's Hospital, Shanghai, China.
⁵ Department of Respiratory Medicine, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China.
⁶ Department of Medical Management, Zhoupu Hospital of Pudong New District, Shanghai, China.
⁷ Department of Respiratory Medicine, Shanghai Pudong New Area People's Hospital, Shanghai, China.
⁸ Department of Pulmonary and Critical Care Medicine, Gongli Hospital, Shanghai, China.
⁹ Department of Infectious Disease, Shanghai Nanhua Hospital of Pudong New District, Shanghai, China.
¹⁰ Department of Respiratory and Critical Care Medicine, Songjiang Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹¹ Department of Respiratory Medicine, Baoshan Branch of Renji Hospital, Shanghai, China.
¹² Department of Respiratory Medicine, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China.
¹³ Department of Respiratory Medicine Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China.
¹⁴ Department of Respiratory Medicine, Shanghai Punan Hospital of Pudong New District, Shanghai, China.
¹⁵ Department of Respiratory and Critical Care Medicine, Jiading Center Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China.
¹⁶ Department of Respiratory and Critical Care Medicine, Shanghai Eighth People's Hospital, Shanghai, China.
¹⁷ Department of Respiratory and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
¹⁸ Department of Respiratory Medicine, Chongming Branch of Xin Hua Hospital Affiliated to School of Medicine, Jiaotong University, Shanghai, China.
¹⁹ Department of Respiratory and Critical Care Medicine, Yangpu Hospital, Tongji University, Shanghai, China.
²⁰ Department of Respiratory Medicine, Xuhui District Central Hospital, Shanghai, China.
²¹ Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
²² Department of Respiratory Medicine, Jing'an District Centre Hospital of Shanghai, Shanghai, China.
²³ Department of Respiratory Medicine, Shanghai Fourth People's Hospital, Shanghai, China.
²⁴ Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
²⁵ Shanghai Public Health Clinical Center, Shanghai, China.
²⁶ Clinical Research Unit, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
²⁷ Department of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.

PMID: 32501440
PMCID: PMC7255260
DOI: 10.1016/S2589-7500(20)30109-6

Observational Study

Assessing risk factors for SARS-CoV-2 infection in patients presenting with symptoms in Shanghai, China: a multicentre, observational cohort study

Bei Mao et al. Lancet Digit Health. 2020 Jun.

. 2020 Jun;2(6):e323-e330.

doi: 10.1016/S2589-7500(20)30109-6. Epub 2020 May 14.

Authors

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Pulmonary and Critical Care Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Department of Respiratory and Critical Care Medicine, Minhang Hospital, Fudan University, Shanghai, China.
⁴ Department of Respiratory and Critical Medicine, Shanghai Tenth People's Hospital, Shanghai, China.
⁵ Department of Respiratory Medicine, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China.
⁶ Department of Medical Management, Zhoupu Hospital of Pudong New District, Shanghai, China.
⁷ Department of Respiratory Medicine, Shanghai Pudong New Area People's Hospital, Shanghai, China.
⁸ Department of Pulmonary and Critical Care Medicine, Gongli Hospital, Shanghai, China.
⁹ Department of Infectious Disease, Shanghai Nanhua Hospital of Pudong New District, Shanghai, China.
¹⁰ Department of Respiratory and Critical Care Medicine, Songjiang Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹¹ Department of Respiratory Medicine, Baoshan Branch of Renji Hospital, Shanghai, China.
¹² Department of Respiratory Medicine, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China.
¹³ Department of Respiratory Medicine Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China.
¹⁴ Department of Respiratory Medicine, Shanghai Punan Hospital of Pudong New District, Shanghai, China.
¹⁵ Department of Respiratory and Critical Care Medicine, Jiading Center Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China.
¹⁶ Department of Respiratory and Critical Care Medicine, Shanghai Eighth People's Hospital, Shanghai, China.
¹⁷ Department of Respiratory and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
¹⁸ Department of Respiratory Medicine, Chongming Branch of Xin Hua Hospital Affiliated to School of Medicine, Jiaotong University, Shanghai, China.
¹⁹ Department of Respiratory and Critical Care Medicine, Yangpu Hospital, Tongji University, Shanghai, China.
²⁰ Department of Respiratory Medicine, Xuhui District Central Hospital, Shanghai, China.
²¹ Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
²² Department of Respiratory Medicine, Jing'an District Centre Hospital of Shanghai, Shanghai, China.
²³ Department of Respiratory Medicine, Shanghai Fourth People's Hospital, Shanghai, China.
²⁴ Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
²⁵ Shanghai Public Health Clinical Center, Shanghai, China.
²⁶ Clinical Research Unit, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
²⁷ Department of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.

PMID: 32501440
PMCID: PMC7255260
DOI: 10.1016/S2589-7500(20)30109-6

Abstract

Background: The outbreak of COVID-19 has led to international concern. We aimed to establish an effective screening strategy in Shanghai, China, to aid early identification of patients with COVID-19.

Methods: We did a multicentre, observational cohort study in fever clinics of 25 hospitals in 16 districts of Shanghai. All patients visiting the clinics within the study period were included. A strategy for COVID-19 screening was presented and then suspected cases were monitored and analysed until they were confirmed as cases or excluded. Logistic regression was used to determine the risk factors of COVID-19.

Findings: We enrolled patients visiting fever clinics from Jan 17 to Feb 16, 2020. Among 53 617 patients visiting fever clinics, 1004 (1·9%) were considered as suspected cases, with 188 (0·4% of all patients, 18·7% of suspected cases) eventually diagnosed as confirmed cases. 154 patients with missing data were excluded from the analysis. Exposure history (odds ratio [OR] 4·16, 95% CI 2·74-6·33; p<0·0001), fatigue (OR 1·56, 1·01-2·41; p=0·043), white blood cell count less than 4 × 10⁹ per L (OR 2·44, 1·28-4·64; p=0·0066), lymphocyte count less than 0·8 × 10⁹ per L (OR 1·82, 1·00-3·31; p=0·049), ground glass opacity (OR 1·95, 1·32-2·89; p=0·0009), and having both lungs affected (OR 1·54, 1·04-2·28; p=0·032) were independent risk factors for confirmed COVID-19.

Interpretation: The screening strategy was effective for confirming or excluding COVID-19 during the spread of this contagious disease. Relevant independent risk factors identified in this study might be helpful for early recognition of the disease.

Funding: National Natural Science Foundation of China.

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Figures

**Figure 1**
Proposed screening strategy for COVID-19 in Shanghai The standardised procedure for COVID-19 screening in the designated hospitals in Shanghai is shown. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2.

**Figure 2**
Visit timeline of suspected patients to fever clinics of the designated hospitals in Shanghai and study population composition (A) Daily numbers of total suspected patients in fever clinics from Jan 17 to Feb 16, 2020. (B) Proportion of suspected patients of total patients from fever clinics (n=53 617), the composition of total suspected patients (n=1004), and the composition of excluded patients (n=816).

**Figure 3**
Clinical features of patients with COVID-19 and excluded patients (A) Age distribution. (B) Distribution of highest body temperature. (C) Clinically significant radiological features. (D) Clinically significant laboratory parameters. *p<0·001. †p<0·01. GGO=ground glass opacity.

See this image and copyright information in PMC

Comment in

Guarding a city from the COVID-19 pandemic.
Xu J, Shang L, Cao B. Xu J, et al. Lancet Digit Health. 2020 Jun;2(6):e275-e276. doi: 10.1016/S2589-7500(20)30111-4. Epub 2020 May 14. Lancet Digit Health. 2020. PMID: 32501438 Free PMC article. No abstract available.

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References

1. Burki T. Outbreak of coronavirus disease 2019. Lancet Infect Dis. 2020;20:292–293. - PMC - PubMed
1. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720. - PMC - PubMed
1. Lipsitch M, Swerdlow DL, Finelli L. Defining the epidemiology of Covid-19—studies needed. N Engl J Med. 2020;382:1194–1196. - PubMed
1. Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV Infection from an asymptomatic contact in Germany. N Engl J Med. 2020;382:970–971. - PMC - PubMed
1. Mahase E. Coronavirus Covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate. BMJ. 2020;368:m641. - PubMed

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[1] Burki T. Outbreak of coronavirus disease 2019. Lancet Infect Dis. 2020;20:292–293. - PMC - PubMed

[2] Burki T. Outbreak of coronavirus disease 2019. Lancet Infect Dis. 2020;20:292–293. - PMC - PubMed

[3] Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720. - PMC - PubMed

[4] Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720. - PMC - PubMed

[5] Lipsitch M, Swerdlow DL, Finelli L. Defining the epidemiology of Covid-19—studies needed. N Engl J Med. 2020;382:1194–1196. - PubMed

[6] Lipsitch M, Swerdlow DL, Finelli L. Defining the epidemiology of Covid-19—studies needed. N Engl J Med. 2020;382:1194–1196. - PubMed

[7] Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV Infection from an asymptomatic contact in Germany. N Engl J Med. 2020;382:970–971. - PMC - PubMed

[8] Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV Infection from an asymptomatic contact in Germany. N Engl J Med. 2020;382:970–971. - PMC - PubMed

[9] Mahase E. Coronavirus Covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate. BMJ. 2020;368:m641. - PubMed

[10] Mahase E. Coronavirus Covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate. BMJ. 2020;368:m641. - PubMed

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Assessing risk factors for SARS-CoV-2 infection in patients presenting with symptoms in Shanghai, China: a multicentre, observational cohort study

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Assessing risk factors for SARS-CoV-2 infection in patients presenting with symptoms in Shanghai, China: a multicentre, observational cohort study

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