Abstract
Background: Respiratory failure is the leading cause of death in patients with COVID-19. This study aimed to assess the incidence and risk factors for respiratory failure in patients with COVID-19 in Jiangsu province, China. Methods: We did a multicentre retrospective cohort study of all patients with COVID-19 diagnosed at 24 hospitals in Jiangsu province, China between 10 January and 18 February 2020. The demographic, clinical, laboratory, and radiologic features at admission were collected. Clinical outcomes were collected at 8 time points over 14 days from hospital admission. The primary outcome was the occurrence of acute respiratory failure within 14 days from admission, defined as oxygen saturation < 93% and/or partial pressure of oxygen in arterial blood < 60 mm Hg on room air and/or requirement of high-flow nasal cannula therapy, non-invasive or invasive mechanical ventilation. Findings: Of the 626 patients with confirmed COVID-19 infection during the study period, 620 (99.0%) had accessible medical records and were included in the study. Respiratory failure (mainly type I) occurred in 53 of 620 (8.6%) patients. As of 18 February 2020, no patients had died and 252 (40.6%) patients had been discharged. Some differences were observed in demographic and clinical characteristics, laboratory parameters, and radiological findings between patients with and without respiratory failure. Multivariate logistic analysis indicated that age (year) (odds ratio [OR], 1.07; 95% confidence interval [CI]: 1.04-1.11; p < 0.0001), respiratory rate (OR, 1.19; 95% CI: 1.05-1.35; p = 0.0052), lymphocyte count (10 -9 /L) (OR, 0.19; 95% CI: 0.06-0.64, p = 0.0089), and pulmonary opacity (per 5%) (OR, 1.29, 95% CI: 1.09-1.52; p = 0.0052) at admission were associated with the occurrence of respiratory failure. Interpretation: The rate of respiratory failure and death was lower in patients with COVID-19 in Jiangsu than in Wuhan city and lower than previously seen in patients with SARS and MERS. Age, lymphocyte count, respiratory rate, and pulmonary opacity score at admission were identified as independent risk factors for developing respiratory failure. Funding Statement: This work was supported, in part, by the research Grant 2020YFC0843700 67 from Ministry of Science and Technology of the People’s Republic of China. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The Ethics Committee of Zhongda Hospital Affiliated to Southeast University approved this study (2020ZDSYLL013–P01 and 2020ZDSYLL019–P01). Informed consent was waived due to the emergent event of the pandemic.
Highlights
The major clinical effects of coronavirus disease 2019 (COVID-19) infection are on the respiratory system other systems can be affected [1, 2]
Patient inclusion criterion was as of 15th March 2020, all patients diagnosed with COVID-19 at 24 hospitals designated to treat COVID-19 in Jiangsu province, China according to the diagnostic criteria of the ‘Diagnosis and treatment protocol for novel coronavirus pneumonia’ released by National Health Commission and National Administration of Traditional Chinese Medicine of China [19]
Of the 721 suspected cases with possible COVID-19 in Jiangsu province from 10th January to 15th March 2020, 90 cases were excluded since RT-PCR tests showed negative results and six cases were excluded due to no available medical records
Summary
The major clinical effects of coronavirus disease 2019 (COVID-19) infection are on the respiratory system other systems can be affected [1, 2]. COVID-19 may result in acute respiratory failure requiring mechanical ventilation and even leading to death [3,4,5,6]. The 28-day mortality could occur in 26%–30% of patients with COVID-19 who had respiratory failure necessitating invasive mechanical ventilation (IMV) [8]. Since the COVID-19 pandemic is still evolving, the true mortality has not been defined, but the crude mortality ratio (the number of reported deaths divided by the number of reported cases) has been estimated to be 3%–4%, which appears to be higher than that for influenza [9]. The infection mortality rate (the number of reported deaths divided by the number of infections) is lower than the crude mortality ratio; and the mortality rate varies among different regions, demographic and socioeconomic characteristics, levels of healthcare access and quality, intervention methods and qualities of reported deaths and cases [9,10,11]. Identifying risk factors of respiratory failure in patients with COVID-19 could help clinicians recognise patients at high risk of respiratory failure and take active treatment for them to prevent further worse outcomes and reduce emergency intubation or cardiopulmonary resuscitation to protect medical staff from related infections
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