Special Report: Fighting The New Coronavirus
A joint US-China research team analyzed the epidemiological and clinical characteristics of 65 patients with new coronavirus infection, revealing some factors related to the risk of death from the disease.
The Preprints with The Lancet published the research results titled "Clinical Characteristics of Deceased Patients Infected with SARS-CoV-2 in Wuhan, China" on March 3, local time.
You can view the paper here: link.
The research team comes from the Union Hospital of Tongji Medical College, Wuhan Huazhong University of Science and Technology, Wuhan Red Cross Hospital, Harvard Medical School's McLean Hospital and other institutions.
Corresponding authors of the article are Lin Zhicheng, director of the Psycho-Neurogenomics Laboratory at Macleans' Hospital, and Xiong Nian, deputy chief physician of the Department of Neurology, Wuhan Union Medical College Hospital.
This is the first time that a team has conducted research and analysis on the epidemiological and clinical characteristics of the dead of new coronavirus infection (Covid-19) in 2019.
The team found that mortality was higher among older patients (especially those over 60) and those with more underlying diseases. The leading causes of death include respiratory failure, circulatory failure, and multiple organ failure.
In addition, they believe that patients with serum CK (creatine kinase), LDH (lactate dehydrogenase) and infection-related biomarkers (including CRP levels) significantly increased or may be used as an important indicator of Covid-19 disease prognosis.
Previous studies have pointed out that with the increase in the number of infections, the mortality rate (CFR) of patients with Covid-19 has decreased, while the CFR of patients in Hubei Province is higher than in other parts of China (14.97% vs 0.52%).
However, no previous studies have explored why the mortality rate in Hubei Province is high. The authors believe that comparing deaths with surviving patients may help identify the main causes and risk factors of deaths associated with new coronavirus infection and better treatment Mild cases, thereby reducing mortality in patients with Covid-19.
The paper collected data from two groups of patients, namely 65 dead patients and 96 surviving patients (COGID-19) confirmed to be admitted to Wuhan Red Cross Hospital from January 21 to February 14, 2020 (control Group), analyzed their epidemiological, demographic, clinical, laboratory, radiological characteristics and treatment data.
All patients underwent laboratory diagnostics and chest CT scans. Treatment options included symptomatic treatment, antiviral therapy, glucocorticoid therapy, and respiratory support.
The results showed that the median age of the 65 dead patients was 67 years (range 31-87 years), of which 52 (80%) were patients over 60 years old, and the majority were males (42, 65%).
In contrast, the median age of surviving patients was younger, at 46 years (range 22-87 years).
Of the 171 patients in both groups, only one under 39 died. 17% (29 of 171 patients) were between the ages of 40-49 years, and 4 of them died. Patients aged 50-59 years accounted for 14% in the survival group and 12% in the death group.
Age and gender of dead and surviving patients
The most common comorbid health problems in patients who died were cardiovascular (39,60%) and endocrine system (21,43%) disease. Common symptoms at the time of their onset are dyspnea (65,100%), fever (59,91%), fatigue (56,86%), anorexia (54,86%), and cough (42,65%). These symptoms Occur more often than surviving patients.
There are also many differences in the results of laboratory tests between the dead and surviving groups. 42% (27) of the 65 dead showed leukocytosis (a white blood cell count of more than 10 x 109/L), while 31% (30) of the 96 surviving patients had leukocytopenia (a white blood cell count of less than 4) x 109/L), only 8% of dead patients have leukocytopenia.
The median neutrophil percentage of dead patients was 90.3% (range 47.5-97.9%), while the median neutrophil percentage of surviving patients was 61.3% (range 33.5-94.7%). The mean percentage of lymphocytes in the death group at the onset of symptoms was lower than in the surviving group.
Blood routine, blood biochemistry, and infection-related biomarker tests of dead and surviving patients
The prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimer levels (3.28 mg/L vs. 0.35 mg/L) were higher at the time of admission of the dead patients than at the time of admission.
The mean urea nitrogen, creatinine, CK (creatine kinase), and LDH (lactate dehydrogenase) were higher in dead patients than in surviving patients.
The average levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were high in 60 (92%) of the 65 dead patients, but less than 30% of surviving patients had Similar AST and ALT levels.
Infection-related biomarkers, including CRP (C-reactive protein, which rises when a patient's body is exposed to inflammatory stimuli such as microbial invasion or tissue damage), also differ significantly between dead and surviving patients.
Of the 65 patients who died, 64 (98%) had at least 1 comorbid condition, including 31 (48%) with acute respiratory injury, 27 (42%) with ARDS (acute respiratory distress syndrome), and acute heart injury. Three cases (5%), 2 cases (3%) of acute kidney injury, and 1 case (2%) of septic shock. In contrast, only 1 of the 96 surviving patients had ARDS (1%).
The CT images of all patients were abnormal, and there were more patients with bronchitis, bilateral pneumonia, multiple intrapulmonary activities, and ground-glass opacities than those who survived (P <0.0001).
In clinical treatment, all 65 death patients received high-flow oxygen inhalation, and 16 (25%) received non-invasive ventilation. In both death and survival groups, most patients received antiviral therapy (oseltamivir, abidol, and ganciclovir), antibacterial therapy (moxifloxacin, ceftriaxone, azithromycin), and intravenous immunoglobulins Protein Therapy (IVIG).
There were more patients in the death group receiving systemic glucocorticoid therapy than survivors (46 [71%] vs. 29 [30%]; P <0.0001). In addition, two of the 65 dead (3%) used extracorporeal membrane oxygenation (ECMO), 1 (2%) of continuous renal replacement therapy (CRRT), and 96 surviving patients. The above treatments were not adopted.
Complications of dead and surviving patients, chest CT and treatment
As of February 14, 2020, a total of 36 patients in the study sample were discharged, with an average hospital stay of 12.5 days (minimum 3 days, maximum 28 days), and other patients remained in the hospital.
The authors say that the main causes of death are acute respiratory injury and acute respiratory distress syndrome. The risk factors are age and underlying diseases, and most of the patients who die have one or more comorbid conditions.
In addition, laboratory indicators show that the PT/APTT/D-dimer content in the blood of the deceased increases significantly after infection, which indicates that the circulatory system is in a high coagulation state and can easily cause pulmonary embolism.
It is worth noting that elevated levels of D-dimer and FDP (fibrinogen degradation products) in patients with Covid-19 are associated with poor prognosis.
The authors also found that elevated levels of CK (creatine kinase), LDH (lactate dehydrogenase), and CRP (C-reactive protein) could be potential markers of Covid-19 prognosis.
CK has been previously reported to be associated with the prognosis of patients with non-muscle invasive papillary upper urothelial carcinoma (UTUC).
Previous studies have also found that LDH levels may pose a potential risk in patients with metastatic germ cell tumors or predict the clinical outcome of patients with advanced cholangiocarcinoma.
In addition, researchers have found that elevated levels of inflammatory factors (such as CRP) can also lead to death.
At the end of the paper, the authors stated that the prevention and early diagnosis of Covid-19 appears to be more important for older people than younger ones.
Given possible false-negative RT-PCR (reverse transcription polymerase chain reaction) results, the authors believe that a chest CT scan may also be an effective screening tool.
At the same time, the authors recommend that patients be tested for viral serum (IgM, IgG) when necessary, which is more sensitive than RT-PCR.
Researchers said that as the susceptibility to the new coronavirus varies from person to person, asymptomatic infections (usually mostly young people) are very likely to become potential sources of infection.
Therefore, disease prevention, early detection and isolation of mild patients are essential to control the disease.
