Retrospective analysis of laboratory testing in 54 patients with severe- or critical-type 2019 novel coronavirus pneumonia

• Published in: Laboratory investigation Vol. 100; no. 6; pp. 794 - 800
• Main Authors: Li, Yanlei, Hu, Yanbing, Yu, Jinyan, Ma, Tiangang
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.06.2020; Nature Publishing Group
• Subjects: 692/699/1785; 692/699/255/2514; Adult; Aged; Aged, 80 and over; Cell number; China; Coagulation; Comorbidity; Coronaviridae; Coronavirus Infections - diagnosis; Coronavirus Infections - physiopathology; Coronaviruses; COVID-19; Cytokines; Degradation products; Dimers; Female; Ferritin; Ferritins - blood; Fibrin; Fibrinogen; Fibrinolysis; Heart Diseases - virology; Humans; Inflammation; Interleukin 2; Interleukin 6; Interleukin-6 - blood; Interleukins; Kidney Diseases - virology; Kidneys; Laboratories; Laboratory Medicine; Laboratory tests; Lymphocyte Count; Lymphocytes; Male; Medicine; Medicine & Public Health; Middle Aged; Pandemics; Pathology; Patients; Peripheral blood; Pneumonia; Pneumonia, Viral - diagnosis; Pneumonia, Viral - physiopathology; Prolongation; Prothrombin; Receptors, Interleukin-2 - blood; Respiratory diseases; Retrospective Studies; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Viral diseases; Young Adult; China
• ISSN: 0023-6837; 1530-0307
• DOI: 10.1038/s41374-020-0431-6

Timely analysis of the laboratory characteristics associated with 2019 novel coronavirus pneumonia (COVID-19) can assist with clinical diagnosis and prognosis. This study is a collection of clinical data from 54 hospitalized adult patients diagnosed with COVID-19 in the Zhongfa Xincheng district of China at Tongji Hospital of Huazhong University of Science and Technology from January 28, 2020 to February 11, 2020. The average age of the patients was 61.8 ± 14.5 years, and the predominant age group was 50–79. The proportion of critical-type patients with comorbidities was higher than that of severe-type patients. Lymphocyte counts were significantly reduced in routine bloodwork for all patients, but significantly lower in critical-type patients than that in severe-type patients. Prolongation of prothrombin times (PT) and elevation of fibrinogen degradation products (FDPs) and D-dimers (D-Ds) were detected in coagulation function tests, and more significant changes were observed in critical-type patients compared to severe-type patients. Serum ferritin levels were sensitive to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but could not be used for disease assessment. In addition, levels of two inflammatory factors, soluble interleukin-2 receptor (sIL-2R) and interleukin-6 (IL-6) were significantly increased in all patients, but higher in critical-type patients than in severe-type patients. Moreover, kidney injury was the second-most common organ affected by COVID-19 followed by heart and liver. Kidney and heart injury were more severe in critical-type patients than in severe-type patients. All of the 31 severe-type patients recovered. Of the critical-type patients, six died and 17 recovered. The length of hospital stay for critical-type patients was significantly longer for severe-type patients. In summary, increased lymphocyte counts, prolonged PT, secondary increases in fibrinolytic activity and increases in sIL-2R and IL-6 are typical features of COVID-19 and are associated with disease severity. This study reports laboratory data and disease outcome of 54 severe- and critical-type COVID-19 hospitalized adult patients in Wuhan, China. Decreased peripheral blood lymphocyte count, prolonged PT, increased secondary fibrinolytic activity, and significantly increased inflammatory factors sIL-2R and IL-6 correlated with the severity of the disease.