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Comparative Study
. 2021 Feb 24;21(1):206.
doi: 10.1186/s12879-020-05728-7.

Differences in the clinical characteristics and outcomes of COVID-19 patients in the epicenter and peripheral areas of the pandemic from China: a retrospective, large-sample, comparative analysis

Gang Wang #  1   2 , Feng Ming Luo #  1   2 , Dan Liu #  1 , Jia Sheng Liu #  3 , Ye Wang  1 , Hong Chen  4 , Pan Wen Tian  1 , Tao Fan  5 , Li Tang  1 , He Yu  1 , Lan Wang  1 , Mei Feng  1 , Zhong Ni  1 , Bo Wang  1 , Zhi Fang Song  1 , Xiao Ling Wu  1 , Hong Jun Wang  6 , Xiang Tong  1 , Miao Xue  1 , Xian Ying Lei  7 , Bo Long  8 , Chao Jia  9 , Jun Xiao  10 , Juan Shang  11 , Nian Xiong #  12   13 , Jian Fei Luo #  14 , Zong An Liang #  15 , Wei Min Li #  16 ; Sichuan & Wuhan Collaboration Research Group, and Sichuan Treatment Expert Group for COVID-19, China
Affiliations
Comparative Study

Differences in the clinical characteristics and outcomes of COVID-19 patients in the epicenter and peripheral areas of the pandemic from China: a retrospective, large-sample, comparative analysis

Gang Wang et al. BMC Infect Dis. .

Abstract

Background: There is limited information on the difference in epidemiology, clinical characteristics and outcomes of the initial outbreak of the coronavirus disease (COVID-19) in Wuhan (the epicenter) and Sichuan (the peripheral area) in the early phase of the COVID-19 pandemic. This study was conducted to investigate the differences in the epidemiological and clinical characteristics of patients with COVID-19 between the epicenter and peripheral areas of pandemic and thereby generate information that would be potentially helpful in formulating clinical practice recommendations to tackle the COVID-19 pandemic.

Methods: The Sichuan & Wuhan Collaboration Research Group for COVID-19 established two retrospective cohorts that separately reflect the epicenter and peripheral area during the early pandemic. The epidemiology, clinical characteristics and outcomes of patients in the two groups were compared. Multivariate regression analyses were used to estimate the adjusted odds ratios (aOR) with regard to the outcomes.

Results: The Wuhan (epicenter) cohort included 710 randomly selected patients, and the peripheral (Sichuan) cohort included 474 consecutive patients. A higher proportion of patients from the periphery had upper airway symptoms, whereas a lower proportion of patients in the epicenter had lower airway symptoms and comorbidities. Patients in the epicenter had a higher risk of death (aOR=7.64), intensive care unit (ICU) admission (aOR=1.66), delayed time from illness onset to hospital and ICU admission (aOR=6.29 and aOR=8.03, respectively), and prolonged duration of viral shedding (aOR=1.64).

Conclusions: The worse outcomes in the epicenter could be explained by the prolonged time from illness onset to hospital and ICU admission. This could potentially have been associated with elevated systemic inflammation secondary to organ dysfunction and prolonged duration of virus shedding independent of age and comorbidities. Thus, early supportive care could achieve better clinical outcomes.

Keywords: COVID-19; Case fatality; Comparative analysis; Epicenter; Pandemic; Peripheral area.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Time of illness onset and hospital admission of patients in the Wuhan cohort; b Distribution of patients with COVID-19 in the Sichuan cohort (The data of administrative areas were downloaded from the Database of Global Administrative Areas [GADM] freely available for academic use and we drew this figure using QGIS software version 3.8.3); c Time of illness onset and hospital admission of patients in the Sichuan cohort
Fig. 2
Fig. 2
a Time of illness onset of patients with or without Wuhan-related exposure in the Sichuan cohort; b Time of hospital admission of patient with or without Wuhan-related exposure in the Sichuan cohort; c The ratio of the number of patients without Wuhan-related exposure to cases with Wuhan exposure in the Sichuan cohort
Fig. 3
Fig. 3
a Symptomatic burden of patients with COVID-19 between Sichuan cohort and Wuhan cohorts; Kaplan-Meier survival curve for time from illness onset to hospital admission (b), to ICU admission (c) and to discharge (d) of patients with COVID-19 between Sichuan and Wuhan cohorts
See this image and copyright information in PMC

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