Abstract
Objective: To describe the clinical manifestations and outcomes of COVID-19, and explore the risk factors of deterioration and death of the disease.Methods: In this retrospective study, we collected data from 121 COVID-19 cases confirmed by RT-PCR and next-generation sequencing in Renmin Hospital of Wuhan University from January 30, 2019, to March 23, 2020, and conducted statistical analysis.Results: A total of 121 patients were included in our study, the median age was 65 years (IQR, 55.0–71.5 years), and 54.5% cases were men. Among those cases, 52 (43.0%) cases progressed to severe, and 14 (11.6%) died. Overall, the most common manifestations were fever (78.5%) and respiratory symptoms (77.7%), while neurological symptoms were found in only 9.9% of the patients. 70.2% of all the cases had comorbidities, including hypertension (40.5%) and diabetes (20.7%). On admission, cases usually show elevated levels of neutrophils (27.3%), D-dimer (72.6%), Interleukin-6 (35.2%), Interleukin-10 (64.4%), high-sensitivity C-reactive protein (82.6%), and lactate dehydrogenase (62.0%), and decreased levels of lymphocytes (66.9%), CD3 cells (67.2%), and CD4 cells (63.0%). The proportional hazard Cox models showed that the risk factors for severity progression and death included comorbidities (HR: 4.53, 95% CI: 1.78–11.55 and HR: 7.81, 95% CI: 1.02–59.86), leukocytosis (HR: 1.13; 95% CI: 1.05–1.22 and HR: 1.25, 95% CI: 1.10–1.42), neutrophilia (HR: 1.15, 95% CI: 1.07–1.13 and HR: 1.28, 95% CI: 1.13–1.46, and elevated LDH (HR: 1.14, 95% CI: 1.12–1.15 and HR: 1.11, 95% CI: 1.10–1.12). Elevated D-dimer (HR: 1.02, 95% CI: 1.01–1.03), IL-6 (HR: 1.01, 95% CI: 1.00–1.02) and IL-10 levels (HR: 1.04, 95% CI: 1.01–1.07) were also risk factors for the progression of disease severity. Meanwhile, lymphopenia and wake immune responses [e.g., lower CD3, CD4, or CD19 counts (all HR < 1)] were associated with disease deterioration and death.Conclusions: Severe cases and death of COVID-19 are associated with older age, comorbidities, organ dysfunction, lymphopenia, high cytokines, and weak immune responses.
Highlights
Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, and is spreading in more than 37 countries, including the United States, Japan, South Korea, Australia, and France [1]
A total of 121 patients were included in our study, the median age was 65 years (IQR, 55.0–71.5 years), and 54.5% cases were men
The proportional hazard Cox models showed that the risk factors for severity progression and death included comorbidities (HR: 4.53, 95% CI: 1.78–11.55 and HR: 7.81, 95% CI: 1.02–59.86), leukocytosis (HR: 1.13; 95% CI: 1.05–1.22 and HR: 1.25, 95% CI: 1.10–1.42), neutrophilia (HR: 1.15, 95% CI: 1.07–1.13 and HR: 1.28, 95% CI: 1.13–1.46, and elevated lactate dehydrogenase (LDH) (HR: 1.14, 95% CI: 1.12–1.15 and HR: 1.11, 95% CI: 1.10–1.12)
Summary
Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, and is spreading in more than 37 countries, including the United States, Japan, South Korea, Australia, and France [1]. The pathogen of COVID-19 was identified to be severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), which is closely related to SARS-like coronavirus [2]. By examining the full-length genome of SARS-CoV-2, it was found that this novel virus shares 87.99% homologous sequences with SARS-like coronavirus [3]. Based on the information up to date, SARS-CoV-2 is believed to be the third zoonotic human coronavirus in this century [4]. Reports from Wuhan found that the COVID19 was SARS-like atypical pneumonia, and can be transmitted from person to person, mainly through respiratory droplets, and through contact with eye mucosa. The severe patients develop acute respiratory distress syndrome, septic shock, and metabolic acidosis that are difficult to manage [5,6,7]. The low fatality and high morbidity of COVID-19 make it difficult to prevent the spread of the virus [8,9,10]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
