Clinical Characteristics of Critically Ill Patients with SARS-CoV-2 Infected Pneumonia (COVID-19) in Wenzhou, China: A Retrospective, Single-Center, Descriptive Study

Abstract

Background: As a very serious city outside Hubei Province, China, Wenzhou had a rapid increase in the number of COVID-19, but clinical characteristics of critically ill patients with COVID-19 was limited.

Methods: A retrospective single-center case series study of 46 confirmed patients with COVID-19 (including 27 critically ill patients) conducted at the First Affiliated Hospital of Wenzhou Medical University in Wenzhou, China from January 29 to February 10, 2020, the last date of follow-up was March 3, 2020.

Findings: All critically ill patients are admitted to the intensive care unit (ICU). Compared to non-critically ill patients with COVID-19, critically ill patients were older ([57.37±14.62] years vs [48.95±11.1]years), more likely to acute cardiac injury (5[18.52%]patients vs 0(0.00%) patients), and more likely to glucocorticoid therapy (14[51.85%] patients vs2[10.53%] patients), oxygen inhalation (24[88.89%]patients vs 3[15.79%] patients), noninvasive ventilation (10[37.04%] patients vs 0[0.00%] patients), invasive ventilation (9[33.33%] patients vs 0[0.00%] patients), extracorporeal membrane oxygenation (5[18.52%]patients vs 0[0.00%] patients) and were more likely to had underlying comorbidities, including hypertension (12[44.44%] vs 5[26.32%]), diabetes 7[25.93%] vs 1[5.26%]) and higher white blood cell (P=0.0217), neutrophil count (P=0.0201), lower lymphocyte cell count (P= 0.004). Further research shown that higher levels of D-dimer (P=0.0099), IL6 (P = 0.0376), IL2 (P = 0.0243), IL10 (P=0.0015), ALT(P =0.0283), AST(P=0.0002), longer positive time of SARS-CoV-2 RNA of throat swab (P=0.0024)while lower T cell (CD3+) count (P=0.0014), CD4+ cell count (P=0.0111), CD8+ cell count (P=0.018), T cell absolute value (P=0.0001), CD4+ absolute value (P= 0.000) and CD8+ absolute value (P = 0.0006) in critically ill patients. We furtherly found that lymphocyte count, D-dimer, CD4+ cell, CD8+ cell, absolute values of CD4+ T cell and absolute values of CD8+ T cell gradually increased while level of IL2, IL10, IL6, IFN-r gradually decreased in critically ill patients with COVID-19 after comprehensive treatment.

Interpretation: In this single-center case series, critically ill patients with COVID-19 were older and more prone to complications, lower lymphocyte count, cytokine storms, serious liver damage, so they needed further monitoring and therapy. The severity of COVID-19 severely poses great pressure the hospital's intensive care resources.

Funding Statement: This study was financially supported by the National Natural Science Foundation of China (81873949, 81672088, 81671968), Medical Innovation Discipline of Zhejiang Province (Critical Care Medicine, Y2015)，Major project co-founded by Zhejiang Province and Ministry of Science and Technology(WKJ-ZJ-1909), Major Science and Technology Project of Wenzhou Science and Technology Bureau(2018ZY002)，Wenzhou Key Laboratory of Critical Care and Artificial Intelligence.

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: This case series was approved by the Institutional Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University (No. YS2020-007), and it complies with the principles of the Helsinki Declaration.