Analysis of clinical features of 58 patients with severe or critical 2019 novel coronavirus pneumonia

Abstract

Objective To analyzethe clinical features of severe or critical 2019 novel coronavirus pneumonia (COVID-19) patients. Methods Clinical data of 58 patients with severe or critical COVID-19 in Wuhan Union Hospital, Tongji medical college of Huazhong University of Science and Technology from January 29 to February 26 in 2020 were collected. The general information, clinical symptoms, resultsofblood testand chest computed tomography (CT) imaging, treatments and outcomes of patients were analyzed retrospectively. Results 36 severe cases (62.1%) and 22 critical cases (37.9%) , 28 males (48.3%) and 30 females (51.7%) , with average age of (62.12±12.95) years were enrolled. 48.2% of the patients had underlying disease including Hypertension (21 cases, 36.2%), Diabetes mellitus (11 cases, 19.0%), Coronary heart disease (6 cases,10.3%), Chronic renal failure (2 cases, 3.4%) and Malignant tumor (1 case, 1.7%). The symptoms included fever (54 cases, 93.1%), dyspnea (48 cases, 82.8%),cough (46 cases, 79.3%), muscle soreness (32 cases, 55.2%), sore throat (15 cases, 25.9%) and diarrhea (6 cases, 10.3%). Decreased or increased white blood cell count was found in 12.1% and 10.3% of the patients.Decreased percent of lymphocyte, increased percent of neutrophil, and decreased hemoglobin level were found in 60.3%, 46.6%, and 41.4% of the patientsrespectively. Elevated CRP, PCT and D-dimmer level were demonstrated in 65.5%, 62.1%, and 77.5% of the cases. Increased level of ALT, AST, LDH and decreased serum albumin were found in 55.2%, 43.1%, 67.2% and 74.1% of all the patients respectively.The main features of CT were patchy shadows and ground glass shadows, bilateral and peripheral distribution, consolidation and interlobular septal thickening were found in most of the patient’s lungs. 29 cases (50.0%) were treated with antibiotics, and 14 cases (24.1%) with systemic glucocorticoid. In addition to supportive and antivirustreatment,oxygen therapy methods including nasal catheter (9 cases, 15.5%), oxygen mask (33 cases, 56.9%), high-flow nasal catheter (8 cases, 13.3%) and invasive mechanical ventilation were adopted in 15.5%, 56.9%, 13.3% and 13.3% of the patients. 21 patients (36.2%) had been discharged from the hospital, 27 patients (46.6%) in remission were still in the isolation wards, 3 patients (5.2%) had been to the ICU as the disease got worse, and 7 patients were dead. Conclusions Abouthalfofthe patients with severe/critical COVID-19 had underlying disease. severe/criticalCOVID-19 patients often showed extrapulmonary abnormity as well as lung dysfunction. Comprehensive treatment as early as possibly may be important for prognosis improvement of these patients. Key words: 2019 novel coronavirus pneumonia; Clinical features; Disease severity