Abstract
ObjectivesTo compare clinical, laboratory, and chest computed tomography (CT) findings in critically ill patients diagnosed with coronavirus disease 2019 (COVID-19) who survived and who died.MethodsThis retrospective study reviewed 60 critically ill patients (43 males and 17 females, mean age 64.4 ± 11.0 years) with COVID-19 pneumonia who were admitted to two different clinical centers. Their clinical and medical records were analyzed, and the chest CT images were assessed to determine the involvement of lobes and the distribution of lesions in the lungs between the patients who recovered from the illness and those who died.ResultsCompared with recovered patients (50/60, 83%), deceased patients (10/60, 17%) were older (mean age, 70.6 vs. 62.6 years, p = 0.044). C-reactive protein (CRP) (110.8 ± 26.3 mg/L vs 63.0 ± 50.4 mg/L, p < 0.001) and neutrophil-to-lymphocyte ratio (NLR) (18.7 ± 16.6 vs 8.4 ± 7.5, p = 0.030) were significantly elevated in the deceased as opposed to the recovered. Medial or parahilar area involvement was observed in all the deceased patients (10/10, 100%), when compared to only 54% (27/50) in the recovered. Ground-glass opacities (97%), crazy-paving pattern (92%), and air bronchogram (93%) were the most common radiological findings. There was significant difference in diabetes (p = 0.025) and emphysema (p = 0.013), and the odds ratio on a deceased patient having diabetes and emphysema was 6 times and 21 times the odds ratio on a recovered patient having diabetes and emphysema, respectively.ConclusionsOlder patients with comorbidities such as diabetes and emphysema, and higher CRP and NLRs with diffuse lung involvement were more likely to die of COVID-19.Key Points• Almost all patients critically ill with COVID-19 pneumonia had five lung lobes involved.• Medial or parahilar area involvement and degree of lung involvement were more serious in the deceased patients when compared with those who recovered from treatment.• Chronic lung disease, e.g., emphysema, diabetes, and higher serum CRP and NLR characterized patients who died of COVID-19.
Highlights
From early December 2019, coronavirus disease 2019 (COVID-19), which is caused by the novel coronavirus (2019-nCoV), has rapidly spread from Wuhan to other regions of China and countries around the world
Almost all patients critically ill with COVID-19 pneumonia had five lung lobes involved
Medial or parahilar area involvement and degree of lung involvement were more serious in the deceased patients when compared with those who recovered from treatment
Summary
From early December 2019, coronavirus disease 2019 (COVID-19), which is caused by the novel coronavirus (2019-nCoV), has rapidly spread from Wuhan to other regions of China and countries around the world. Management of critically ill patients is important to reduce the mortality of COVID-19. In China, the reported incidence of critical illness in COVID-19 patients was 17.7% in Wuhan, 10.4% in the Hubei Province, and 7.0% in areas outside the Hubei Province [2]. These figures necessitate attention since the incidence of critical illness among the Chinese medical staff afflicted with COVID-19 was 14.6% [2]. According to a recent study by Guan et al who reported the clinical characteristics of COVID-19 in China through an analysis of 1099 patients, 173 (15.7%) had severe disease with a mortality of 8.1%, which was significantly higher than that in the non-severe patients (0.1%) [3]. It is imperative to recognize both the clinical and imaging characteristics, achieving superior patient management
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