Delayed Hospitalization Tends to Cause More Extrapulmonary Organ Injures for Patients with Coronavirus Disease 2019

Background: Coronavirus disease 2019 (COVID-19) is of great global public health concern. However, the impacts of delayed hospitalization on patients are not documented.Methods: One hundred and fifty-eight patients enrolled from two hospitals were used to assess the severity of COVID-19. Among them, 56 patients matched with age, sex and disease severity were used to compare the clinical differences in and outside Wuhan.Findings: The total computed tomography (CT) score, a quantitative score developed with assessment of the number, quadrant, and area of lesions in CT, tended to perform better than assessment just based on the number or the area of lesions (p = 0•0004 and 0•0887, respectively). Multivariate logistic regression showed that the total CT score, chest tightness, lymphocyte, and lactate dehydrogenase (LDH) were independent factors for severe COVID-19. After age, sex and disease severity matched, the time from onset to hospitalization of patients in Wuhan was significantly longer than outside Wuhan (p < 0•001). Patients in Wuhan presented more frequent exposure history and fatigue, and higher lymphocyte, platelets, alanine aminotransferase, total bilirubin, direct bilirubin, creatine kinase, thrombin time, and activated partial thromboplastin time than patients outside Wuhan. C-reactive protein, albumin, and LDH levels of patients in Wuhan were significantly lower than those of patients outside Wuhan. However, after adjusted by time from onset to hospitalization, most differences were not significant any more.Interpretation: Total CT score was a simple and feasible score for predicting severe COVID-19. Delayed hospitalization tended to cause more extrapulmonary organ injures in COVID-19 patients.Funding Statement: This work was funded by the National Science and Technology Major Project of China (2018ZX10302205), and the Personnel Plan of Jiangxi Science and Technology Department (2016BCD40015).Declaration of Interests: The authors have declared that no conflict of interest exists.Ethics Approval Statement: This study was conducted in compliance with the principles of the 1975 Declaration of Helsinki and was approved by the Ethics Committees of the above two hospitals. Written informed consent was obtained from all patients or their legal representatives.