TABLE I.
Clinical Characteristics of 10 Patients with Fracture*
| Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | Case 6 | Case 7 | Case 8 | Case 9 | Case 10 | Total No. of Patients with Finding | |
| Clinical characteristics | |||||||||||
| Sex, age (yr) | F, 50 | F, 34 | F, 87 | F, 79 | F, 80 | F, 84 | M, 76 | F, 55 | M, 85 | F, 54 | — |
| Date of admission | Jan 2, 2020 | Jan 31, 2020 | Jan 13, 2020 | Jan 19, 2020 | Jan 20, 2020 | Jan 30, 2020 | Jan 17, 2020 | Feb 3, 2020 | Jan 16, 2020 | Feb 12, 2020 | — |
| Orthopaedic diagnosis | Intertrochanteric fracture | Femoral fracture | Lumbar fracture | Femoral neck fracture | Intertrochanteric fracture | Intertrochanteric fracture | Intertrochanteric fracture | Fracture of radius | Intertrochanteric fracture | Thoracolumbar fracture | — |
| Epidemiological history | Yes (exposure to relevant environment) | Yes (exposure to relevant environment) | Yes (exposure to relevant environment) | Yes (exposure to relevant environment) | Yes (exposure to relevant environment) | Yes (contact with infected person) | Yes (exposure to relevant environment) | Yes (exposure to relevant environment) | No | Yes (exposure to relevant environment) | 9 |
| Complications | Hypertension, diabetes | No | COPD, osteoporosis | Osteoporosis | Hypertension, diabetes, CAHD | Hypertension, osteoporosis | Cirrhosis, Alzheimer disease | No | Brain injury | Hypertension, diabetes | — |
| Orthopaedic operation | Jan 9, 2020 | No | No | Jan 21, 2020 | No | No | Jan 20, 2020 | No | No | No | 3 |
| Signs and symptoms | |||||||||||
| Fever | Yes | No | No | Yes | Yes | Yes | Yes | No | Yes | Yes | 7 |
| Cough | Yes | No | No | Yes | Yes | Yes | Yes | Yes | Yes | No | 7 |
| Fatigue | Yes | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | 7 |
| Sore throat | No | No | No | No | Yes | No | Yes | Yes | Yes | No | 4 |
| Dyspnea | Yes | No | Yes | No | Yes | No | Yes | No | Yes | No | 5 |
| Chest pain | No | No | No | No | Yes | No | No | No | No | No | 1 |
| Nasal congestion | No | No | No | No | Yes | No | No | No | No | No | 1 |
| Headache | No | No | No | No | Yes | No | No | No | No | No | 1 |
| Dizziness | No | No | No | No | Yes | Yes | No | Yes | No | No | 3 |
| Diarrhea | No | No | No | No | No | No | No | No | No | No | 0 |
| Abdominal pain | No | No | Yes | No | No | No | No | No | No | No | 1 |
| Vomiting | No | No | Yes | No | No | No | No | No | No | No | 1 |
| Limited activity | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
| Laboratory test results† | |||||||||||
| White blood-cell count (×109/L) | 13.45 (↑↑) | 4.93 | 21.9 (↑↑) | 12.37 (↑↑) | 6.43 | 6.95 | 9.6 | 4.23 | 11.27 (↑↑) | 5.21 | 4 |
| Neutrophil count (×109/L) | 11.25 (↑↑) | 3.7 | 20.4 (↑↑) | 11.45 (↑↑) | 5.24 | 4.98 | 7.48 | 3.04 | 10.06 (↑↑) | 3.6 | 4 |
| Lymphocyte count (×109/L) | 1.44 | 0.83 (↓↓) | 0.8 (↓↓) | 0.59 (↓↓) | 0.47 (↓↓) | 1.11 | 1.48 | 0.93 (↓↓) | 0.46 (↓↓) | 1.09 | 6 |
| Monocyte count (×109/L) | 0.58 | 0.33 | 0.8 (↑) | 0.33 | 0.5 | 0.85 (↑) | 0.64 (↑) | 0.24 | 0.72 (↑) | 0.33 | 4 |
| Platelet count (×109/L) | 213 | 157 | 144 | 153 | 291 | 178 | NA | 189 | 106 (↓) | 167 | 1 |
| APTT (s) | 146.7 (↑) | 26.4 (↓) | 38.3 | 31.2 | 30.3 | 31.76 | 32.2 | 29.8 | 35.5 | 38.5 | 1, 1 |
| PT (s) | 75.9 (↑) | 12.4 | 13.9 | 10.3 (↓) | 12.2 | 12.95 | 13.9 | 10.4 (↓) | 13.4 | 12.8 | 1, 2 |
| D-dimer (mg/L) | 5.32 (↑) | NA | 12.45 (↑) | 12.45 (↑) | 2.35 (↑) | 5.23 (↑) | 1,622 (↑) | 1,155 (↑) | 17.02 (↑) | 6.73 (↑) | 9 |
| Albumin (g/L) | 28.7 (↓) | 33.9 (↓) | 34 (↓) | 39.8 | 33.4 (↓) | 33.8 (↓) | 28.4 (↓) | 38.6 | 37.1 | 40.6 | 6 |
| ALT (U/L) | 0 | 20 | 15 | 15 | 10 | 42 (↑) | 15 | 5 | 18 | 36 (↑) | 2 |
| AST (U/L) | 12 | 46 (↑) | 35 | 29 | 21 | 64 (↑) | 38 | 20 | 27 | 33 | 2 |
| Total bilirubin (μmol/L) | 7.7 | 9.1 | 18.8 | 6.8 | 9.2 | 14 | 41.8 (↑) | 10 | 10.3 | 18 | 1 |
| Blood urea nitrogen (mmol/L) | 13.44 (↑) | 5.43 | 18.8 (↑) | 6.0 | 2.98 | 10.68 (↑) | 17.79 (↑) | 3.8 | 6.8 | 3.19 | 4 |
| Creatinine (μmol/L) | 419.3 (↑) | 42 (↓) | 298 (↑) | 42 (↓) | 136 (↑) | 104 | 78 | 37 (↓) | 88 | 55.5 | 3, 3 |
| Procalcitonin (ng/mL) | NA | 0.009 | 19.05 (↑) | 0.219 (↑) | 0.15 (↑) | 0.74 (↑) | 0.23 (↑) | NA | 2.35 (↑) | 0.41 (↑) | 7 |
| C-reactive protein (mg/L) | 156.9 (↑) | 6.8 (↑) | 33 (↑) | 96 (↑) | 18.9 (↑) | 14.5 (↑) | NA | 13.12 (↑) | 16.4 (↑) | 11.4 (↑) | 9 |
| Evidence of COVID-19 | |||||||||||
| SARS-CoV-2 quantitative RT-PCR | Negative | Negative | NA | Positive | Negative | Positive | Positive | Positive | Positive | Positive | 6 |
| Typical signs of viral infection on CT | Bilateral | Unilateral | Bilateral | Bilateral | Bilateral | Bilateral | Bilateral | Bilateral | Bilateral | Bilateral | 10 |
| Treatment | |||||||||||
| Oxygen inhalation | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 9 |
| Antiviral therapy | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
| Antibacterial therapy | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
| Intravenous immunoglobulin therapy | Yes | No | No | No | Yes | No | Yes | No | No | No | 3 |
| Glucocorticoid therapy | Yes | No | No | Yes | No | Yes | No | No | Yes | No | 4 |
| CKRT | Yes | No | No | No | No | No | No | No | No | No | 1 |
| NIV | No | No | Yes | No | Yes | No | Yes | No | No | No | 3 |
| IMV | No | No | No | No | No | No | No | No | No | No | 0 |
| ECMO | No | No | No | No | No | No | No | No | No | No | 0 |
| Co-infection | Coxsackie virus | No | No | Epstein-Barr virus | No | No | Candida | No | No | No | 3 |
| Clinical outcome | Remained in hospital | Remained in hospital | Died on Jan 21, 2020 | Remained in hospital | Remained in hospital | Died on Feb 7, 2020 | Died on Jan 31, 2020 | Remained in hospital | Died on Jan 24, 2020 | Remained in hospital |
COPD = chronic obstructive pulmonary disease, CAHD = coronary atherosclerosis heart disease, CKRT = continuous kidney replacement therapy, NIV = noninvasive ventilation, IMV = invasive mechanical ventilation, ECMO = extracorporeal membrane oxygenation, NA = not available.
White blood-cell count: normal range, 3.5 to 9.5 × 109/L, (↑↑) indicates leukocytosis (>10.0 × 109/L). Neutrophil count: normal range, 1.8 to 6.3 × 109/L, (↑↑) indicates neutrophilic granulocytosis (>7.5 × 109/L). Lymphocyte count: normal range, 1.1 to 3.2 × 109/L, (↓↓) indicates lymphopenia (<1.0 × 109/L). For the remaining laboratory values, the normal ranges are as follows: monocyte count, 0.1 to 0.6 × 109/L; platelet count, 125 to 350 × 109/L; APTT, 28.0 to 43.5 s; PT, 11.0 to 16.0 s; D-dimer, <0.5 mg/L FEU (fibrinogen equivalent units); albumin, 35 to 55 g/L; alanine aminotransferase (ALT), 5 to 35 U/L; aspartate aminotransferase (AST), 8 to 40 U/L; total bilirubin, 5.1 to 19.0 μmol/L; blood urea nitrogen, 2.9 to 8.2 mmol/L; creatinine, 44.0 to 106.0 μmol/L; procalcitonin, <0.05 ng/mL; C-reactive protein, 0 to 5 mg/L. For those values, (↑) or (↓) indicates an increase or decrease compared with the normal level.