Study design and populations
A consecutive 2-year prospective
study from December 2017 to February 2020 was conducted in 2 tertiary
hospitals in China: Beijing Tongren Hospital and the First People’s
Hospital of Lianyungang City. During the study period, all patients aged
≥ 18 years with CAP admitted to the emergency department, general wards,
or ICUs were screened for enrollment and selected with a positive
multiplex PCR result within the 72 hours following their admission.
Patients were diagnosed with pneumonia according to the guideline
published by the American Thoracic Society (ATS) in 2007 [23].
Patients were excluded if one of the following criteria was met: 1)
aspiration pneumonia; 2) had a clear alternative final diagnosis at the
end of follow-up as lung cancer or other non-pneumonia illness; 3) long
hospitalization > 90 days before death. The study protocol
was approved by the medical ethical committees of the hospitals. The
requirement for written informed patient content was waived because all
data were anonymous and the observational nature of the study.
During the study period, 528 hospitalized CAP patients were eligible for
enrollment, and 272 of them had initial positive RT-PCR results. A total
of 17 cases were excluded for final diagnosis of non-pneumonia illness
(N = 8), age < 18 years (N = 4), or being lost to follow-up (N
= 3), or aspiration pneumonia (N = 2). Finally, a total of 255 pneumonia
patients with positive viral detection were included in this analysis
(Supplementary Figure 1).