Clinical outcomes of COVID-19 in Wuhan, China: a large cohort study

• Published in: Annals of intensive care Vol. 10; no. 1; pp. 99 - 21
• Main Authors: Liu, Jiao, Zhang, Sheng, Wu, Zhixiong, Shang, You, Dong, Xuan, Li, Guang, Zhang, Lidi, Chen, Yizhu, Ye, Xiaofei, Du, Hangxiang, Liu, Yongan, Wang, Tao, Huang, SiSi, Chen, Limin, Wen, Zhenliang, Qu, Jieming, Chen, Dechang
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 31.07.2020; Springer Nature B.V; SpringerOpen
• Subjects: Anesthesiology; Antiviral drugs; Clinical outcomes; Cohort analysis; Coronaviruses; COVID-19; Critical Care Medicine; Development; Diabetes; Emergency Medicine; Intensive; Intensive care; Laboratories; Medicine; Medicine & Public Health; Mortality; Risk factors; Severe; Severe acute respiratory syndrome coronavirus 2; Thrombocytopenia; Wuhan China; China; COVID-19; Development; Severe; Mortality; Risk factors
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-020-00706-3

Background Since December 2019, an outbreak of Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) initially emerged in Wuhan, China, and has spread worldwide now. Clinical features of patients with COVID-19 have been described. However, risk factors leading to in-hospital deterioration and poor prognosis in COVID-19 patients with severe disease have not been well identified. Methods In this retrospective, single-center cohort study, 1190 adult inpatients (≥ 18 years old) with laboratory-confirmed COVID-19 and determined outcomes (discharged or died) were included from Wuhan Infectious Disease Hospital from December 29, 2019 to February 28, 2020. The final follow-up date was March 2, 2020. Clinical data including characteristics, laboratory and imaging information as well as treatments were extracted from electronic medical records and compared. A multivariable logistic regression model was used to explore the potential predictors associated with in-hospital deterioration and death. Results 1190 patients with confirmed COVID-19 were included. Their median age was 57 years (interquartile range 47–67 years). Two hundred and sixty-one patients (22%) developed a severe illness after admission. Multivariable logistic regression demonstrated that higher SOFA score (OR 1.32, 95% CI 1.22–1.43, per score increase, p  < 0.001 for deterioration and OR 1.30, 95% CI 1.11–1.53, per score increase, p  = 0.001 for death), lymphocytopenia (OR 1.81, 95% CI 1.13–2.89 p  = 0.013 for deterioration; OR 4.44, 95% CI 1.26–15.87, p  = 0.021 for death) on admission were independent risk factors for in-hospital deterioration from not severe to severe disease and for death in severe patients. On admission D-dimer greater than 1 μg/L (OR 3.28, 95% CI 1.19–9.04, p  = 0.021), leukocytopenia (OR 5.10, 95% CI 1.25–20.78), thrombocytopenia (OR 8.37, 95% CI 2.04–34.44) and history of diabetes (OR 11.16, 95% CI 1.87–66.57, p  = 0.008) were also associated with higher risks of in-hospital death in severe COVID-19 patients. Shorter time interval from illness onset to non-invasive mechanical ventilation in the survivors with severe disease was observed compared with non-survivors (10.5 days, IQR 9.25–11.0 vs. 16.0 days, IQR 11.0–19.0 days, p  = 0.030). Treatment with glucocorticoids increased the risk of progression from not severe to severe disease (OR 3.79, 95% CI 2.39–6.01, p  < 0.001). Administration of antiviral drugs especially oseltamivir or ganciclovir is associated with a decreased risk of death in severe patients (OR 0.17, 95% CI 0.05–0.64, p  < 0.001). Conclusions High SOFA score and lymphocytopenia on admission could predict that not severe patients would develop severe disease in-hospital. On admission elevated D-dimer, leukocytopenia, thrombocytopenia and diabetes were independent risk factors of in-hospital death in severe patients with COVID-19. Administration of oseltamivir or ganciclovir might be beneficial for reducing mortality in severe patients.