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Novel Insights of Illness Evolution And Mortality Risk Profiles for the Non-Survivors with COVID-19

25 Pages Posted: 8 Apr 2020

See all articles by Liang Shao

Liang Shao

Wuhan University - Department of Hematology

Xinyi Li

Wuhan University - Department of Anesthesiology

Yi Zhou

Wuhan University - Department of Hematology

Yalan Yu

Wuhan University - Department of Hematology

Yanan Liu

Wuhan University - Department of Hematology

Minghui Liu

Wuhan University - Department of Hematology

Ruixian Zhang

Chinese Center for Disease Control and Prevention (China CDC) - Yunnan Center for Disease Control and Prevention

Haojian Zhang

Wuhan University - Frontier Science Center for Immunology and Metabolism, Medical Research Institute

Xinghuan Wang

Wuhan University - Center for Evidence-Based and Translational Medicine

Fuling Zhou

Wuhan University - Department of Hematology

More...

Abstract

Background: The outbreak of COVID-19 has attracted the attention of the whole world. Our study aims to describe illness evolution and mortality risk profiles for non-survivors.

Methods: We retrospectively analyzed 155 patients with COVID-19 in Wuhan and focused on eighteen non-survivors among them. We compared the dynamic profile of laboratory data from hospital admission date to death date of the patients. The survival curve was analyzed by Kaplan-Meier.

Findings: Of the non-survivors, the median age was 73·5 years old and the proportion of males was 72·2%. Fifteen individuals had chronic medical illnesses. Five and thirteen patients were hospital-acquired and community-acquired infections, respectively. Five were co-infected with other pathogens. The interval between disease onset and diagnosis was 8·5 days (IQR, [4-11]). With the deterioration of the disease, most patients gradually developed lymphopenia, increased WBC and neutrophil counts, decreased platelet count, decreased total plasma protein and albumin, as well as elevated D-dimer. Notably, procalcitonin were dynamically increased from their admission date to death date. These patients exhibited decreased CD3+T, CD3+CD4+Th, and CD3+CD8+Tc cell count in the peripheral blood. All patients died within 45 days after hospitalization, with the median survivor time of 13·5 days (IQR, 8-17).

Interpretation: We drew a clear picture of disease progression in non-survivors. Our data showed biochemical and immune parameters dynamically changed during illness evolution in non-survivors, suggesting the importance of early intervention.

Funding Statement: The study was supported by the Key Project for Anti-2019 novel Coronavirus Pneumonia from the Ministry of Science and Technology, China (no. 2020YFC0845500).

Declaration of Interests: We declare no competing interests.

Ethics Approval Statement: This study was conducted according to the principles of Helsinki and approved by the Ethics Committee of Zhongnan Hospital of Wuhan University (No.2020063). Due to the urgent need for this emerging epidemic, the requirements for informed consent from patients were waived.

Keywords: COVID-19, non-survivor, clinical course, co-infection, mortality, immune dysfunction

Suggested Citation

Shao, Liang and Li, Xinyi and Zhou, Yi and Yu, Yalan and Liu, Yanan and Liu, Minghui and Zhang, Ruixian and Zhang, Haojian and Wang, Xinghuan and Zhou, Fuling, Novel Insights of Illness Evolution And Mortality Risk Profiles for the Non-Survivors with COVID-19 (3/18/2020). Available at SSRN: https://ssrn.com/abstract=3559596 or http://dx.doi.org/10.2139/ssrn.3559596

Liang Shao

Wuhan University - Department of Hematology

China

Xinyi Li

Wuhan University - Department of Anesthesiology

Wuhan
China

Yi Zhou

Wuhan University - Department of Hematology

China

Yalan Yu

Wuhan University - Department of Hematology

China

Yanan Liu

Wuhan University - Department of Hematology

China

Minghui Liu

Wuhan University - Department of Hematology

China

Ruixian Zhang

Chinese Center for Disease Control and Prevention (China CDC) - Yunnan Center for Disease Control and Prevention

Yunan
Cayman Islands

Haojian Zhang

Wuhan University - Frontier Science Center for Immunology and Metabolism, Medical Research Institute

Wuhan
China

Xinghuan Wang

Wuhan University - Center for Evidence-Based and Translational Medicine

Wuhan, 430071
China

Fuling Zhou (Contact Author)

Wuhan University - Department of Hematology ( email )

China