Clinical Characteristics and Risk Factors for Severe Outcomes of Novel Coronavirus Infection, January–March 2020, Japan

Tsuchihashi, Yuuki; Arima, Yuzo; Takahashi, Takuri; Kanou, Kazuhiko; Kobayashi, Yusuke; Sunagawa, Tomimasa; Suzuki, Motoi

BACKGROUND: Notifications of novel coronavirus infections increased in early 2020 in Japan. We described characteristics of novel coronavirus infection cases and analyzed risk factors for severe outcomes. METHODS: Cases were persons with laboratory-confirmed novel coronavirus infection reported under national surveillance between January and March 2020. Clinical characteristics were described, and risk factors of (1) intensive care unit [ICU] admission and (2) invasive ventilation/death were analyzed using Poisson regression. RESULTS: Among the 516 cases analyzed, median age was 60 years (range: 1–97 years) and 285 (55%) were male. Common symptoms/signs were fever (375/475, 79%), cough (353/465, 76%), and pneumonia (245/387, 63%). Ten (2%) cases died. Of the 348 cases with data, 50 (14%) required invasive ventilation. Adjusted for each other, male gender and 1-year increase in age were associated with ICU admission (risk ratio [RR] 4.18; 95% confidence interval [CI], 1.69–10.32 and RR 1.05; 95% CI, 1.03–1.08, respectively) and invasive ventilation/death (RR 2.79; 95% CI, 1.49–5.21 and RR 1.06; 95% CI, 1.04–1.08, respectively). Diabetes, dyslipidemia, hyperuricemia, and lung diseases were also associated with severe outcomes. Of the 80 cases asymptomatic at hospitalization, 40 developed symptoms and five of them >70 years of age required invasive ventilation. CONCLUSIONS: The early stage of the novel coronavirus epidemic in Japan disproportionately affected the elderly. Older age, male gender, and underlying conditions were associated with severe outcomes. Notably, some elderly case-patients who were asymptomatic at diagnosis and promptly hospitalized still went on to develop severe disease, indicating the importance of careful monitoring of certain populations.