key: cord-0955270-wit4v3n6 authors: Leung, Char title: Clinical features of deaths in the novel coronavirus epidemic in China date: 2020-03-16 journal: Rev Med Virol DOI: 10.1002/rmv.2103 sha: 1f23c0841a619a814cc5ae82775269b28a2183bc doc_id: 955270 cord_uid: wit4v3n6 In response to the recent novel coronavirus outbreak originating in Wuhan, Hubei province, China, observations concerning novel coronavirus mortality are of urgent public health importance. The present work presents the first review of the fatal novel coronavirus cases in China. Clinical data of fatal cases published by the Chinese Government were studied. As of 2 February 2020, the clinical data of 46 fatal cases were identified. The case fatality rate was significantly higher in Hubei province than the rest of China. While 67% of all deceased patients were male, gender was unlikely to be associated with mortality. Diabetes was likely to be associated with mortality. There is, however, not yet sufficient evidence to support the association between hypertension and mortality as similar prevalence of hypertension was also observed in the Hubei population. age or gender of the deceased patient was stated. Both official documents and press conferences were considered. The following data were abstracted: gender, age, time from symptom onset to hospital admission, time from hospital admission to death, medical history and first symptoms. For each of the measure studied, a confidence interval for the central tendency was calculated (eg, proportion for male, mean for age). The computation was done in a spreadsheet, Microsoft Office Excel version 2016. A regression model was estimated by regressing the time from hospital admission to death on other variables. The computation was done with the software R and the adjusted R 2 was used for the model selection criterion. Moreover, different functional forms were attempted to ensure normally distributed residuals free from autocorrelation and heteroskedasticity. Forty-six fatal cases were identified and included in the study including 39 cases in Hubei, 5-7 one in Chongqing, 8 two in Henan, 9 two in Heilongjiang, 10 one in Hebei 11 and one in Sichuan. 12 Of the seven cases outside Hubei, three had a travel history to Wuhan. Demographic and common clinical characteristics are illustrated in Table 1 . The average age was 70.6 years (n = 45, 95% CI 52.0-80.5) with no significant difference between men and women (t test P = .80). Eighty-four percent of all deceased patients were of age 60 or above. Men accounted for 67.4% (95% CI 52.0%-80.5%) of all deceased patients. While the time from first symptom onset to hospital admission was normally distributed with mean 6.2 days, the time from hospital admission to death was log-normally distributed (with mean 11 days and median 5 days), as suggested by the Jarque-Bera normality test (P = .56) on the log-transformed data. Therefore, the log-transformed time from hospital admission to death was regressed in the model. Based on the adjusted R 2 , the time from symptom onset to hospital admission, cardiovascular and cerebrovascular comorbidities, and age were selected as the independent variables (Table 2 ). With the exception of cardiovascular and cerebrovascular comorbidities, all other variables are significant at 5% level. The signs of the coefficients are reasonable as the time from hospitalisation to death was inversely related to age and the time from symptom onset to hospitalisation. The statistical significance of time from symptom onset to hospital suggests the need of timely hospitalisation. In fact, the coefficient of time from symptom onset to hospital admission means that, for any two identical patients who will eventually expire with hospital admission 1 day apart, the expected time from hospital admission to death of the patient with later hospital admission is 8.5% shorter than that of the other patient, all else being equal. Although a patient was admitted to the hospital for palpitation on 26 November 2019, it is important to note that palpitation was not a common symptom of COVID-19 infection. 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