Clinical characteristics of 36 non-survivors with COVID-19 in Wuhan, China

  1. Ying Huang
  2. Rui Yang
  3. Ying Xu
  4. Ping Gong

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Abstract

Background

Although the outbreak of Coronavirus disease 2019 (COVID-19) has caused over 2200 deaths in China, there was no study about death yet. We aimed to describe the clinical characteristics of non-survivors with COVID-19.

Methods

For this retrospective, single-center study, we included 36 non-survivors with COVID-19 in the Fifth Hospital of Wuhan. Cases were confirmed by real-time RT-PCR between Jan 21 and Feb 10, 2020 according to the recommended protocol. The epidemiological, demographic, clinical, laboratory, radiological and treatment data were collected and analyzed. Outcomes were followed up until Feb 14, 2020. This study was approved by the ethics commissions of the Fifth Hospital of Wuhan, with a waiver of informed consent due to a public health outbreak investigation.

Findings

We included 36 patients who died from COVID-19. The mean age of the patients was 69.22 years (SD 9.64, range 50-90). 25(69.44%) patients were males, and 11 (30.56%) female. 26 (72.22%) patients had chronic diseases, mainly including hypertension, cardiovascular disease and diabetes. Patients had common clinical symptoms of fever (34 [94.44%] patients), cough (28 [77.78%] patients), shortness of breath (21 [58.33%] patients), and fatigue (17 [47.22%] patient). Chest computed tomographic scans showed that 31 (96.88%) patients had bilateral pneumonia. Lymphopenia (lymphocyte count, 0.67□×□109/L [SD, 0.33]) occurred in 24 patients (70.59%), decreased albumin (30.18, [SD, 4.76]) in 25 patients (80.65%), elevated D-dimer (8.64 [IQR, 2.39-20]) in 27 patients (100%), and elevated lactate dehydrogenase (502.5 U/L [IQR, 410-629]) in 26 patients (100%). Nearly all of the patients have elevated CRP (106.3 mg/L [IQR, 60.83-225.3]), PCT (0.61 ng/ml [IQR, 0.16-2.10]) and IL-6 (100.6 pg/ml [IQR, 51.51-919.5]). Most patients received antiviral therapy and antibiotic therapy, and more than half of patients received glucocorticoid therapy (25 [69.44%]). All the patients had acute respiratory distress syndrome (ARDS). The median time from onset to ARDS was 11 days. One (2.78%) patient presented with acute renal injury. The median time from onset to death was 17 days.

Interpretation

Lots of patients died from COVID-19 till now. The median survival time of these non-survivors from onset to death was about 2 weeks. Most patients were older males with comorbidities. They finally progressed to ARDS. The median time from onset to ARDS was 11 days. Gradually decreased lymphocytes and increased inflammation biomarkers were common, and need to be monitored in the routine treatment.

Funding

There is no any funder involved in this study.

Research in context

Evidence before this study

SARS-CoV-2 has been spreading in China as well as in other countries. We searched PubMed for articles published up to Feb 15, 2020. Serveral articles that describe the epidemiological and clinical characteristics of general COVID-19 patients. However, special reports about dead cases of COVID-19 were limited but warranted, considering the large amount of confirmed cases, which is still increasing

Added value of this study

We retrospectively analysed specific clinical information of 36 non-survivors infected with SARS-CoV-2 in this single-centered study. Most patients were older males with comorbidities. Gradually decreased lymphocytes and increased inflammation biomarkers were found in these patients. They finally progressed to ARDS. The median time from onset to ARDS was 11 days. The mean survival time in our cohort of COVID-19 non-survivors was about 2 weeks.

Implications of all the available evidence

Lots of patients died from COVID-19 till now. The median survival time of these non-survivors from onset to death was about 2 weeks. Most patients were older males with comorbidities. They finally progressed to ARDS. Early detection and intervention of patients are especially important which can delay the development from mild to severe cases.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.02.27.20029009: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: This study was approved by the ethics commissions of hospital, with a waiver of informed consent due to a public health outbreak investigation.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    This study has several limitations. First, only 36 dead cases were included. However, this is the largest cohort about the non-survivors of COVID-19 up to now. Second, some specific clinical information was insufficient, such as mechanical ventilation settings, oxygen concentration, and detailed medication history. Third, this is a retrospective, single-centered study. It may be limited to the hospital critical care resources. Further studies are still needed. In conclusion, most non-survivors are older men with comorbidities (especially cardiovascular diseases). They finally progressed to ARDS. The median time from onset to ARDS was 11 days. The mean survival time in our cohort of COVID-19 non-survivors was about 2 weeks. Gradually decreased lymphocytes and increased inflammation biomarkers were found in these patients, and need to be monitored in the routine treatment. Early detection and intervention of patients are especially important which can delay the development from mild to severe cases.

    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

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  2. Version published to 10.1101/2020.02.27.20029009 on medRxiv