Clinical progression and changes of chest CT findings among asymptomatic and pre-symptomatic patients with SARS-CoV-2 infection in Wuhan, China

ABSTRACT

Objectives

To analyze characteristics of asymptomatic/pres-ymptomatic patients with SARS-CoV-2 infection.

Methods

Chest computed tomography(CT), indicators for organ and coagulation function, inflammation cytokines, of asymptomatic/pre-symptomatic patients with SARS-CoV-2 infection were retrospectively analyzed in Zhongnan Hospital of Wuhan University from 20 December 2019, to 8 March 2020.

Results

The proportion of normal chest CT in asymptomatic and pre-symptomatic patients with SARS-CoV-2 infection were 35.4% (17/48) and 3.3%(2/61), respectively (P< 0.001). In 17 asymptomatic patients, their images of chest CT maintained normal during the whole course of diseases, while the normal images of chest CT in 2 pre-symptomatic patients progressed to abnormal later (P< 0.001). All the six asymptomatic patients with SARS-CoV-2 infection maintained unilateral lesion, while the proportion was 29.4%(5/17) in pre-symptomatic patients(P= 0.003). Compared with asymptomatic patients, pre-symptomatic COVID-19 patients had worse levels of Lymphocyte count (P= 0.001), Albumin (P= 0.045), Aspartate aminotransferase (P= 0.044), γ-glutamyl transpeptadase (P= 0.016), Globulin (P= 0.036), Creatinine (P= 0.021), Lactate dehydrogenase (P= 0.008), C-reactive protein (P< 0.001), Serum amyloid A (P< 0.001), and Erythrocyte sedimentation rate (P< 0.001). Except for above indicators, Alkaline phosphatase (P= 0.009), Procalcitonin (P= 0.010), and D-dimer(P< 0.001) increased further during periods of symptoms compared with those levels in pre-symptomatic period.

Conclusion

In early stage after SARS-CoV-2 infection, images of chest CT and blood tests of asymptomatic patients were different from pre-symptomatic patients.

KEYWORDS:

• Coronavirus disease 2019
• severe acute respiratory syndrome coronavirus-2
• asymptomatic patients
• presymptomatic patients
• aspartate aminotransferase
• D-dimer

Article highlights

• In asymptomatic patients with SARS-CoV-2 infection, the proportion of patients with normal chest CT was higher than that in pre-symptomatic patients.

• In asymptomatic patients with SARS-CoV-2 infection, all those patients with unilateral pulmonary lesion sustained local damage during the whole course of disease.

• In pre-symptomatic patients with SARS-CoV-2 infection, 70.6% of those with unilateral pulmonary lesion during pre-symptomatic period progressed to bilateral damage when symptoms appeared.

• The levels of lymphocyte count, indicators of organ function tests and inflammatory factors were different between asymptomatic and pre-symptomatic patients with SARS-CoV-2 infection.

• In pre-symptomatic patients with SARS-CoV-2 infection, the levels of lymphocyte count, indicators of organ function tests and inflammatory factors progressed further when symptoms appeared.

Authors’ contributions

All authors collected the clinical data. R. Yang, Y. Xiong, and S. Gao drafted the manuscript. X. Gui, Y. Xiong, and H. Ke supervised the final manuscript. All authors were responsible for summarizing all data related to this study.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by the Fundamental Research Funds for the Central Universities and Medical Science Advancement Program (Basical Medical Sciences) of Wuhan University, Grant No. TFJC2018002; Supported by National Natural Science Foundation of China (Grant No. 81572902).