Abstract
ObjectiveThis study aimed to evaluate the factors associated with death in patients with coronavirus disease 2019 by clarifying the clinical characteristics and immune responses.MethodsThe clinical characteristics and laboratory findings, including cytokine and lymphocyte subsets, were obtained from the electronic medical records of patients in Wuhan Tongji Hospital.ResultsThis study included 836 patients with confirmed COVID-19. In total, 699 (83.6%) were cured and discharged, and 137 (16.4%) died. Our analysis revealed that age ≥ 65 years, male sex, malignancy, chronic obstructive pulmonary disease, dyspnea, dizziness, respiratory rate > 20 bpm, heart rate > 100 bpm, systolic blood pressure < 90 mmHg, neutrophils > 6.3×109/L, lymphopenia, thrombocytopenia, D-dimer ≥ 0.5 mg/L, lactate dehydrogenase > 250 U/L, aspartate aminotransferase > 40 U/L, total bilirubin > 26 μmol/L, albumin < 35 g/L, blood urea nitrogen > 9.5 mmol/L, estimated glomerular filtration rate < 90 ml/min/1.73, elevated cardiac troponin I, N-terminal pro-brain natriuretic peptide ≥ 900 pg/ml, C-reactive protein ≥ 25 mg/L, procalcitonin ≥ 0.05 ng/ml and ferritin > 400 μg/L were associated with death in patients with COVID-19. The multivariate logistic regression analysis revealed that an estimated glomerular filtration rate < 90 ml/min/1.73, elevated cardiac troponin I, C-reactive protein ≥ 25 mg/L and procalcitonin ≥ 0.05 ng/ml were predictive of mortality. Regarding immune responses, IL-2R, IL-6, IL-8, IL-10, and TNFα were remarkably higher in the deceased group at admission, and the levels of IL-2R, IL-6, IL-8, IL-10, and TNFα in the deceased group showed a rapid increase; the dynamics of these cytokines were highly consistent with disease deterioration. Lymphocyte subset analysis revealed that the deceased patients showed significant decreases in lymphocyte counts, especially helper T cells, suppressor T cells and NK cells.ConclusionsThis study identified that an estimated glomerular filtration rate < 90 ml/min/1.73, elevated cardiac troponin I, C-reactive protein ≥ 25 mg/L and procalcitonin ≥ 0.05 ng/ml were predictors of mortality in COVID-19 patients. Elevated cytokine levels and a continued increasing trend, including in IL-2R, IL-6, IL-8, IL-10 and TNFα, and a decrease in lymphocyte subsets, especially helper T cells, suppressor T cells and NK cells, were associated with a poor prognosis.
Highlights
A new type of coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was discovered to be the cause of unexplained pneumonia cases in Wuhan, China, in late December 2019 (Zhu et al, 2020)
Our results showed that age ≥ 65 years, male sex, malignancy, chronic obstructive pulmonary disease, dyspnea, dizziness, respiratory rate > 20 bpm, heart rate > 100 bpm, systolic blood pressure < 90 mmHg, neutrophils > 6.3×109/L, lymphopenia, thrombocytopenia, D-dimer ≥ 0.5 mg/L, lactate dehydrogenase > 250 U/L, aspartate aminotransferase > 40 U/L, total bilirubin > 26 mmol/L, albumin < 35 g/L, blood urea nitrogen > 9.5 mmol/L, estimated glomerular filtration rate < 90 ml/min/1.73, elevated cardiac troponin I, N-terminal pro-brain natriuretic peptide ≥ 900 pg/ml, C-reactive protein ≥ 25 mg/L, procalcitonin ≥ 0.05
We found that older age, male sex, baseline diseases such as hematological and neoplastic disorders and COPD, the presence of dyspnea and dizziness, deterioration of vital signs, evidence of increased acute inflammation and end organ damage at admission were associated with an increased risk of mortality due to COVID-19 infection, which is consistent with the results of previous clinical studies (Tian et al, 2020)
Summary
A new type of coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was discovered to be the cause of unexplained pneumonia cases in Wuhan, China, in late December 2019 (Zhu et al, 2020). On February 11, 2020, the disease caused by the new coronavirus was officially named coronavirus disease 2019 (COVID-19) by the WHO. Most COVID-19 cases have mild or moderate symptoms, but severe cases can be combined with acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS) and even death. The World Health Organization has recently declared COVID19 a public health emergency of international concern. We performed a comprehensive exploration of the clinical features of 836 patients with confirmed COVID-19 who were transferred or admitted to the isolation ward of a Wuhan hospital. We evaluated 137 patients who died and 699 patients who recovered; our hope is that this study can aid clinicians in the early identification of patients with a poor prognosis
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