Clinical characteristics and survival analysis in critical and non-critical patients with COVID-19 in Wuhan, China: a single-center retrospective case control study

Ran Tian,Qingfeng Luo,Xiang Zhou,Xiaowei Yan,Fan Guo,Zhengyin Liu,Yan Qin,Chunyao Wang,Zhiyu Zhang,Shuyang Zhang,Peng Gao,Haopeng Xu,Hao Qian,Haiyu Pang,Jinglan Wang,Taisheng Li,Jihua Shi,Wenbin Li,Wei Wu

doi:10.1038/s41598-020-74465-3

Abstract

Since the outbreak of COVID-19 in China at the end of 2019, the world has experienced a large-scale epidemic caused by the SARS-CoV-2. The epidemiological and clinical course of COVID-19 patients has been reported, but there have been few analyses about the characteristics, predictive risk factors, and outcomes of critical patients. In this single-center retrospective case–control study, 90 adult inpatients hospitalized at Tongji Hospital (Wuhan, China) were included. Demographic, clinical, laboratory tests, and treatment data were obtained and compared between critical and non-critical patients. We found that compared with non-critical patients, the critical patients had higher SOFA score and qSOFA scores. Critical patients had lower lymphocyte and platelet count, elevated D-dimer, decreased fibrinogen, and elevated high-sensitivity C-reactive protein (hsCRP), and interleukin-6(IL-6). More critical patients received treatment including antibiotics, anticoagulation, corticosteroid, and oxygen therapy than non-critical ones. Multivariable regression showed higher qSOFA score and elevation of IL-6 were related to critical patients. Antibiotic usage and anticoagulation were associated with decreased in-hospital mortality. And critical grouping contributed greatly to in-hospital death. Critical COVID-19 patients have a more severe clinical course. qSOFA score and elevation of IL-6 are risk factors for critical condition. Non-critical grouping, positive antibiotic application, and anticoagulation may be beneficial for patient survival.

Highlights

Since the outbreak of COVID-19 in Wuhan, Hubei at the end of 2019, China has experienced another largescale epidemic disease caused by a coronavirus after Severe Acute Respiratory Syndrome (SARS)
We found that qSOFA scores and increased IL-6 were significantly associated with critical group (Table 3)
As seen in other literatures, the risk of complications is higher in critical patients, including respiratory failure, acute respiratory distress syndrome (ARDS), secondary infections, myocardial injury, liver and kidney dysfunction, etc.[9,10]

Summary

Introduction

Since the outbreak of COVID-19 in Wuhan, Hubei at the end of 2019, China has experienced another largescale epidemic disease caused by a coronavirus after Severe Acute Respiratory Syndrome (SARS). By the end of August 24, 2020, the number of confirmed cases in China exceeded 8, 4981, with more than 4600 d eaths[1]. This disease has spread to 216 countries, areas or territories, with a total of 23,311,719 infected cases and 806,410. According to the diagnosis and treatment guidelines released by China Health and Medical Commission[4], patients can be divided into four types clinically: mild, ordinary, severe and critical. We present the clinical course and outcomes of a group of critical patients with COVID-19, and attempt to identify risk factors for disease progression and in-hospital mortality in these patients. We aim to find some predictive risk factors for early warning, to provide opportunities for timely medical intervention by simple and effective assessment

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Conclusion