Retrospective Analysis of Clinical Features in 101 Death Cases with COVID-19
Abstract
Background
In December 2019, viral pneumonia outbreaks caused by the novel coronavirus occurred in Wuhan, China, and spread rapidly worldwide, the illness progress of coronavirus disease 2019(COVID-19) in partial patients is rapid and the mortality rate is relatively high. The present study aims to describe the clinical features in the death cases with COVID-19.
Methods
In this single center and observational study, we recruited 101 death cases with COVID-19 from Dec 30, 2019 to Feb 16, 2020 in Intensive Care Unit (ICU) of Wuhan Jinyintan Hospital. Demographics, underlying diseases, X-ray/CT images, possible therapy strategies and test results were collected and analyzed on patients admission to the ICU and 48 hours before deaths.
Findings
Of 101 COVID-19 dead cases, 47 patients went directly to the ICU because of critical condition, and 54 patients were transferred to ICU with aggravated condition. Over fifty six percent (56.4%) of patients were laboratory confirmed by RT-PCR, and 43.6% were consistent with clinical diagnostic criteria.Among them, 64 were males and 37 were females, with average age of 65.46 years (SD 9.74). Interestingly, all deaths shwed significant difference in blood type distribution, with 44.44% of type A, 29.29% of type B, 8.08% of type AB, and 18.19% of type O.The clinical manifestations of the novel coronavirus pneumonia are non-specific,the common symptoms included fever (91,,90.10%), cough (69,68.32%) and dyspnea (75,74.26%). Neutrophils, procalcitonin(PCT),C-reactive protein(CRP),and interleukin-6(IL-6), D-dimer gradually increased with progress of the disease. Myocardial enzymes were abnormal in most patients at admission, myocardial damage indicators were significantly increased. Sixty one (60.40%) patients were given antiviral drugs, 59(58.42%),received glucocorticoids, 63.37% were given intravenous immunoglobulins, and 44.55% were treated with thymosin preparations. All patients received antibiotic treatment, 63(62.38%) were given restricted antibiotics, 23(22.78%) were administrated to antifungal drugs. Non-invasive ventilator or high-flow oxygen therapy were given in 84(83.17%) patients, and invasive mechanical ventilation was used in 76.24% patients. The median time from acute respiratory distress syndrome(ARDS) to invasive mechanical ventilation was 3.00 days(IQR 0.00-6.00). The duration of invasive mechanical ventilation was 5 days (IQR2.00-8.00).
Interpretation
Critical COVID-19 can cause fatal respiratory distress syndrome and multiple organ failure with high mortality. The blood group distribution of the deaths remarkably differred from that of Han population in Wuhan.Heart may be the earliest damaged organ except the lungs. Hospital-acquired pneumonia(HAP) in the later period is worthy of attention.
Funding
Supported by “the Fundamental Research Funds for the Central Universities (WK9110000037)”.
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