Clinical Characteristics of Fatal and Recovered Cases of Coronavirus Disease 2019 in Wuhan, China: A Retrospective Study
The outbreak of the 2019 novel coronavirus (2019-nCoV) in Wuhan, Hubei Province, China, in December 2019, has led to a global pandemic of coronavirus disease 2019 (COVID-19). This study aimed to analyze the clinical characteristics of patients who succumbed to and those who recovered from COVID-19, providing insights into the disease’s progression and potential treatment strategies.
Patients and Study Design The study was conducted as a retrospective investigation at two tertiary hospitals in Wuhan, including the Tongji Hospital and The Central Hospital of Wuhan. The study period spanned from January 1, 2020, to February 21, 2020. A total of 109 patients who died during hospitalization (death group) and 116 patients who recovered and were discharged (recovered group) were enrolled. All patients were diagnosed according to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 6) issued by the National Health Commission of the People’s Republic of China. Severe cases were defined based on specific criteria, including respiratory rate, oxygen saturation, and arterial partial pressure of oxygen. The criteria for discharge included negative throat swab tests, normal body temperature for three consecutive days, resolved symptoms, and significant improvement in chest computed tomography findings.
Laboratory Confirmation Throat swab specimens were tested using real-time reverse transcription polymerase chain reactions (RT-PCR) to confirm 2019-nCoV infection. Specific primers and probes were used for the RT-PCR assay, and the amplification conditions were set according to standard protocols.
Data Collection Data on age, gender, underlying diseases, clinical presentations, complications, laboratory findings, and treatment regimens were collected from clinical charts and nursing records. Laboratory tests included blood cell count, alanine transaminase (ALT), aspartate transaminase (AST), creatinine, and C-reactive protein (CRP). Treatment regimens such as intravenous corticosteroids, gammaglobulin, antiviral drugs, antibiotics, antifungal drugs, and respiratory support were also recorded.
Statistical Analysis Statistical analysis was performed using SPSS Statistics 23.0 software. Continuous variables were presented as median (interquartile range) and analyzed using the Mann-Whitney U test. Categorical variables were presented as counts and percentages and analyzed by the chi-square test or Fisher’s exact test. A p-value of less than 0.05 was considered statistically significant.
Results General Characteristics The median age of the death group was significantly older than the recovered group (69 [62, 74] vs. 40 [33, 57] years, p < 0.001). More male patients were in the death group (67.0% vs. 44.0%, p < 0.001). The death group had a higher prevalence of underlying diseases (72.5% vs. 41.4%, p < 0.001), particularly hypertension, lung disease, and heart disease.
Clinical Manifestations The death group had a significantly higher proportion of patients with dyspnea (70.6% vs. 19.0%, p < 0.001) and expectoration (32.1% vs. 12.1%, p < 0.001) at admission. Blood oxygen saturation was significantly lower in the death group (85 [77, 91]% vs. 97 [95, 98]%, p < 0.001). The time from illness onset to hospitalization was longer in the death group (10.0 [6.5, 12.0] vs. 7.0 [5.0, 10.0] days, p = 0.001).
Laboratory Findings Patients in the death group exhibited significantly higher white blood cell (WBC) count (7.23 [4.87, 11.17] vs. 4.52 [3.62, 5.88] ×10^9/L, p < 0.001) and lower lymphocyte count (0.63 [0.40, 0.79] vs. 1.00 [0.72, 1.27] ×10^9/L, p < 0.001) at admission. Lymphocyte percentage continued to decrease during hospitalization in the death group. ALT, AST, and creatinine levels were significantly higher in the death group. CRP levels were also significantly higher in the death group at admission (109.25 [35.00, 170.28] vs. 3.22 [1.04, 21.80] mg/L, p < 0.001) and remained high after treatment.
Complications and Treatment The death group had more complications such as acute respiratory distress syndrome (ARDS) (89.9% vs. 8.6%, p < 0.001), acute cardiac injury (59.6% vs. 0.9%, p < 0.001), acute kidney injury (18.3% vs. 0%, p < 0.001), shock (11.9% vs. 0%, p < 0.001), and disseminated intravascular coagulation (DIC) (6.4% vs. 0%, p = 0.006). More patients in the death group received high-grade antibiotics, antifungal drugs, and intravenous corticosteroids. The length of hospital stay was shorter in the death group (8 [4, 13] vs. 16 [12, 20] days, p < 0.001).
Discussion The study highlighted that patients in the death group were older, had more pre-existing comorbidities, and exhibited more severe symptoms such as dyspnea and lower oxygen saturation at admission. Laboratory findings indicated higher WBC count, lower lymphocyte count, and elevated CRP levels in the death group. The death group also had more severe complications, including ARDS, acute cardiac injury, acute kidney injury, shock, and DIC. The findings suggest that early identification and management of these risk factors could improve outcomes in COVID-19 patients.
In conclusion, this retrospective study provides valuable insights into the clinical characteristics of fatal and recovered cases of COVID-19. The findings underscore the importance of early hospitalization, monitoring of oxygen saturation, and management of comorbidities in improving patient outcomes. Further research is needed to explore the role of different treatment regimens and the long-term effects of COVID-19 on survivors.
doi.org/10.1097/CM9.0000000000000824
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