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Early and Critical Care in Severe Patients with COVID-19 in Jiangsu Province, China: A Descriptive Study
24 Pages Posted: 3 Mar 2020More...
Background: Patients with coronavirus disease 2019 (COVID-19) infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which originated in Wuhan, China, and spreading over the country including Jiangsu Province. Our study aimed to study the epidemiological, clinical characteristics and therapies of these severe cases in Jiangsu Province.
Methods: Patients with severe COVID-19 pneumonia who were admitted to 12 first-tier hospitals in Jiangsu Province between Jan 24 and Feb 23, 2020 were retrospective enrolled. All diagnosis were confirmed by real-time reverse transcription polymerase chain reaction (RT-PCR). Clinical characteristics and prognosis of 60 cases with COVID-19 were compared and analysis.
Findings: A total of 631 infected cases with COVID-19 in Jiangsu Province, 60 of which were severe cases. Up until Feb 23, 2020, the mortality rate of these severe patients was 0%. The median age was 57 years (range, 26 to 97), and 58 · 3% were man. The body mass index (BMI) of these patients was higher, with an average of 25 kg/m2. 51 · 7% of cases had at least one comorbidity. Mean acute physiology and chronic health evaluation (APACHE) II score on admission was 14±5. Acute respiratory distress syndrome (ARDS) appeared in 15% of the patients. White blood cell counts decreased in 45 · 0% of patients, lymphopenia in 63 · 3%, thrombocytopenia in 13 · 3%, and procalcitonin levels in 88 · 3% of the patients were less than 0 · 5 ng/mL. There were no statistically significant differences in immunoglobulin therapy and glucocorticoids therapy between the improvement and deterioration subgroups ( P >0 · 05). Logistic regression analysis showed higher levels of troponin T (odds ratio [OR]: 1 · 04; 95% confidence interval [CI]: 1 · 00-1 · 08; P =0 · 04), antiviral therapy with interferon (OR: 6 · 33; 95% CI: 1 · 18-33 䟞 P =0 · 03), and the application of non-invasive mechanical ventilation (OR: 1 · 99; 95%CI: 1 · 17-3 · 41; P =0 · 01) correlated with disease progression, wherea higher lymphocyte count (OR: 0 · 11; 95% CI: 0 · 02-0 · 57; P =0 · 01) and prone ventilation were associated with improvement (OR: 0 · 11; 95% CI: 0 · 01-0 · 98; P =0 · 04).
Interpretation: The COVID-19 had a low mortality rate in Jiangsu Province, China. In patients with severe COVID-19 pneumonia, early comprehensive care and oxygen support therapy are the key to success treatment. With non-invasive ventilation or high flow nasal cannula combined prone ventilation might additionally improve hypoxia and protect organ function.
Funding Statement: The authors stated that this research was not funded.
Declaration of Interests: The authors declare no financial conflicts of interest.
Ethics Approval Statement: The research was approved by independent Ethics Committee of the First Affiliated Hospital of Nanjing Medical University. The requirement for written informed consent was waived by the ethics committee.
Keywords: COVID-19; Severe cases; Clinical data
Suggested Citation: Suggested Citation