Clinical features and progression of acute respiratory distress syndrome in coronavirus disease 2019

  1. Yanli Liu
  2. Wenwu Sun
  3. Jia Li
  4. Liangkai Chen
  5. Yujun Wang
  6. Lijuan Zhang
  7. Li Yu

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Abstract

Background

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) results in a cluster of coronavirus disease 2019 (COVID-19). We reported the clinical characteristics of COVID-19 patients with acute respiratory distress syndrome (ARDS), and further investigated the treatment and progression of ARDS in COVID-19.

Methods

This study enrolled 109 patients with COVID-19 admitted to the Central Hospital of Wuhan, a designated hospital in Wuhan, China, from January 2 to February 1, 2020. Patients were followed up to February 12, 2020. The clinical data were collected from the electronic medical records. The differences in the treatment and progression with the time and the severity of ARDS were determined.

Findings

Among 109 patients, mean age was 55 years, and 59 patients were male. With a median 15 days (range, 4 to 30 days) follow-up period, 31 patients (28.4%) died, while 78 (71.6%) survived and discharged. Of all patients, 53 (48.6%) developed ARDS. Compared to non-ARDS patients, ARDS patients were elder (mean age, 61 years vs . 49 years), and more likely to have the coexistent conditions, including diabetes (20.8% vs . 1.8%), cerebrovascular disease (11.3% vs . 0%), and chronic kidney disease (15.1% vs . 3.6%). Compared to mild ARDS patients, those with moderate and severe ARDS had higher mortality rates. No significant effect of antivirus, glucocorticoid, or immunoglobulin treatment on survival was observed in patients with ARDS.

Interpretation

The mortality rate increased with the severity of ARDS in COVID-19, and the effects of current therapies on the survival for these patients were not satisfactory, which needs more attention from clinicians.

Funding

Health and Family Planning Commission of Wuhan Municipality.

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  1. ScreenIT

    SciScore for 10.1101/2020.02.17.20024166: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: All data were anonymous, and the requirement for informed consent was waived.
    IRB: The Ethics Committees of the Central Hospital of Wuhan approved this study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The dynamic trajectory in laboratory parameters was plotted using GraphPad Prism 8 (GraphPad Software, Inc).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The present study is subjected to several limitations. Due to the retrospective nature of the present study, a systematic selection bias could be introduced. We could not completely address the residual confounding factors as well. Although our laboratory observations showed the significant changes with the time and the severity of ARDS, the clinical predictive value remained to be determined. In addition, our results on the effect of the current treatments should be considered with caution, and high-quality clinical interventional studies are needed. Meanwhile, the benefits of the invasive ventilation therapy on the disease prognosis should be further investigated. In the future, a multi-center and follow-up study with a larger cohort is eagerly warranted.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.02.17.20024166v3 on medRxiv
  3. Version published to 10.1101/2020.02.17.20024166v2 on medRxiv
  4. Version published to 10.1101/2020.02.17.20024166v1 on medRxiv