Clinical Characteristics And Risk Factors For Fatal Outcome in Patients With 2019-Coronavirus Infected Disease (COVID-19) in Wuhan, China

Abstract

Background: Increasing numbers of confirmed cases and deaths due to 2019-coronavirus infected disease (COVID-19) have occurred in Wuhan, China since December 2019. However, there is currently no effective antiviral treatment. Information is scarce on clinical characteristics of COVID-19 or risk factors associated with death.

Methods: From January 1 to February15, data was retrospectively collected from cured discharged cases and death cases with COVID-19 with complete data at the Seventh Hospital of Wuhan City.Confirmation of COVID-19 enrolled in this study were diagnosed according to the interim guidance of the World Health Organization. Clinical characteristics, laboratory findings on admission and the complications and treatment during Hospitalization were compared between discharged cases and death cases. Risk factors were evaluated for predicting death.

Findings: Compared with the discharged patients, those who died (death group) had a higher percentage of men, were older, and had higher rates of hypertension, coronary heart disease and cardiomyopathy ( P = 0.006, <0.001, 0.04, 0.007,0.019 respectively). The death group also had significantly higher rates of fever and dyspnea. The median duration from symptom onset to discharge or death were 22.1 (IQR 17--28) and 17.7 (IQR, 13--23) days respectively. On admission, patients who later died showed higher WBC, lower lymphocyte, and lower platelet counts ( P < 0.001, =0.015, <0.001). The death group had higher D-dimer, high-sensitivity C-reactive protein (hsCRP), procalcitonin, troponin T (TnT), and N-terminal pro-brain natriuretic peptide (NT-proBNP), and lower PaO₂/FiO₂, and significantly higher levels of creatinine and aspartate aminotransferase, and lower albumin ( P < 0.001, all). The logistic regression analysis indicated that TnT, D-dimer, PaO₂/FiO₂, and hsCRP independently predicted mortality. During hospitalization, The median durations from admission to the use of mechanical ventilation and death were only 4.6 (IQR 1-5) and 9.2 (IQR 4-14) days, respectively. The death group were more commonly to have complications of Acute Respiratory Distress Syndrome(ARDS), acute cardiac injury, acute coagulopathy, acute kidney injury and shock compared with the discharged group (P<0.001, all). The death group utilized a significantly higher percentage of hormone therapy, respiratory support compared with the discharged group, the utilization of angiotensin-Converting Enzyme Inhibitors and angiotensin Receptor Blockers exhibited no statistical difference in the two groups.

Interpretation: The identified independent risk factors (elevated TnT, CRP, and D-dimer, and declined PaO₂/FiO₂) suggest that fatality due to COVID-19 was associated with multiple organ dysfunction. The independent risk factors found in this research can help identify the high-risk patients of COVID-19 with poor prognosis in order to offer early warning and intervention, and also help funnel the flow of patient with COVID-19.

Funding Statement: This work was supported by support funding for disciplinary development of Zhongnan Hospital of Wuhan University.

Declaration of Interests: All authors declare no competing interests.

Ethics Approval Statement: The institutional ethics board of Zhongnan Hospital of Wuhan University and the Seventh Hospital of Wuhan City (No. 2020026) approved the research protocol.

Keywords: 2019-Coronavirus Infected Disease (COVID-19); clinical characteristics of death with COVID-19; risk factors for mortality