Early identification and contribution factor analysis of severe coronavirus disease 2019 in Xinyang city of Henan province_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Mengdie ¹ , ZHAN Weiqiang ¹ , HAN Tao ¹ , WU Min ¹ , XU Ming ¹ , LI Chengzhang ² ,  LU Yibin ¹

1. Department of Critical Care Medicine, Xinyang Central Hospital, Xinyang, Henan 464000, P. R. China;
2. Department of Infectious Diseases, The Fifth People's Hospital of Xinyang, Xinyang, Henan 464000, P. R. China;

Corresponding author：

LU Yibin, Email: luyb6810@163.com

Keywords：

Coronavirus disease 2019; Acute respiratory distress syndrome; Severity; Contribution factors

DOI：

10.7507/1671-6205.202003203

Video：

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Objective To investigate the clinical characteristics and contribution factors in severe coronavirus disease 2019 (COVID-19).Methods The clinical symptoms, laboratory findings, radiologic data, treatment strategies, and outcomes of 110 COVID-19 patients were retrospectively analyzed in these hospitals from Jan 20, 2020 to Feb 28, 2020. All patients were confirmed by fluorescence reverse transcription polymerase chain reaction. They were classified into a non-severe group and a severe group based on their symptoms, laboratory and radiologic findings. All patients were given antivirus, oxygen therapy, and support treatments. The severe patients received high-flow oxygen therapy, non-invasive mechanical ventilation, invasive mechanical ventilation or extracorporeal membrane oxygenation. The outcomes of patients were followed up until March 15, 2020. Contribution factors of severe patients were summarized from these clinical data.Results The median age was 50 years old, including 66 males (60.0%) and 44 females (40.0%). Among them, 45 cases (40.9%) had underlying diseases, and 108 cases (98.2%) had different degrees of fever. The common clinical manifestations were cough (80.0%, 88/110), expectoration (33.6%, 37/110), fatigue (50.0%, 55/110), and chest tightness (41.8%, 46/110). Based on classification criteria, 78 (70.9%) non-severe patients and 32 (29.1%) severe patients were identified. Significant difference of the following parameters was found between two groups (P<0.05): age was 47 (45, 50) years vs. 55 (50, 59) years (Z=–2.493); proportion of patients with underlying diseases was 27 (34.6%) vs. 18 (56.3%) (χ²=4.393); lymphocyte count was 1.2 (0.9, 1.5)×10⁹/L vs. 0.6 (0.4, 0.7)×10⁹/L (Z=–7.26); C reactive protein (CRP) was 16.2 (6.5, 24.0) mg/L vs. 45.3 (21.8, 69.4) mg/L (Z=–4.894); prothrombin time (PT) was 15 (12, 19) seconds vs. 18 (17, 19) seconds (Z=–2.532); D-dimer was 0.67 (0.51, 0.82) mg/L vs. 0.98 (0.80, 1.57) mg/L (Z=–5.06); erythrocyte sedimentation rate (ESR) was 38.0 (20.8, 59.3) mm/1 h vs. 75.5 (39.8, 96.8) mm/1 h (Z=–3.851); lactate dehydrogenase (LDH) was 218.0 (175.0, 252.3) U/L vs. 325.0 (276.5, 413.5) U/L (Z=–5.539); neutrophil count was 3.1 (2.1, 4.5)×10⁹/L vs. 5.5 (3.7, 9.1)×10⁹/L (Z=–4.077). Multivariable logistic analysis showed that there was positive correlation in elevated LDH, CRP, PT, and neutrophil count with the severity of the disease. Currently, 107 patients were discharged and 3 patients died. Total mortality was 2.7%.Conclusions Old age, underlying diseases, low lymphocyte count, elevated CPR, high D-dimer and ESR are relevant to the severity of COVID-19. LDH, CPR, PT and neutrophil count are independent risk factors for the prognosis of COVID-19.

Citation： LI Mengdie, ZHAN Weiqiang, HAN Tao, WU Min, XU Ming, LI Chengzhang, LU Yibin. Early identification and contribution factor analysis of severe coronavirus disease 2019 in Xinyang city of Henan province. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(4): 317-324. doi: 10.7507/1671-6205.202003203 Copy

1.	Vetter P, Vu DL, L'Huillier AG, et al. Clinical features of covid-19. BMJ, 2020, 369: m1470.
2.	中华人民共和国国家卫生健康委员会办公厅. 新型冠状病毒感染的肺炎诊疗方案(试行第七版)[EB/OL]. [2020-03-04](2020-03-15).
3.	Jonsdottir HR, Dijkman R. Coronaviruses and the human airway: a universal system for virus-host interaction studies. Virol J, 2016, 13: 24.
4.	Arabi YM, Alothman A, Balkhy HH, et al. Treatment of Middle East respiratory syndrome with a combination of lopinavir- ritonavir and interferon-β1b (MIRACLE trial): study protocol for a randomized controlled trial. Trials, 2018, 19(1): 81.
5.	Lansbury L, Rodrigo C, Leonardi-Bee J, et al. Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev, 2019, 2(2): CD010406.
6.	Wang YP, Liao BL, Guo Y, et al. Clinical characteristics of patients infected with the novel 2019 coronavirus (SARS-Cov-2) in Guangzhou, China. Open Forum Infect Dis, 2020, 7(6): ofaa187.
7.	Huang DZ, Lian XJ, Song FE, et al. Clinical features of severe patients infected with 2019 novel coronavirus: a systematic review and meta-analysis. Ann Transl Med, 2020, 8(9): 576.
8.	Suleyman G, Fadel RA, Malette KM, et al. Clinical characteristics and morbidity associated with coronavirus disease 2019 in a series of patients in Metropolitan Detroit. JAMA Netw Open, 2020, 3(6): e2012270.
9.	Badawi A, Ryoo SG. Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. Int J Infect Dis, 2016, 49: 129-133.
10.	Channappanavar R, Fett C, Mack M, et al. Sex-based differences in susceptibility to severe acute respiratory syndrome coronavirus infection. J Immunol, 2017, 198(10): 4046-4053.
11.	Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med, 2020, 382(18): 1708-1720.
12.	Zheng CC, Wang JQ, Guo H, et al. Risk-adapted treatment strategy for COVID-19 patients. Int J Infect Dis, 2020, 94: 74-77.
13.	Takeuchi A, Saito T. CD4 CTL, a cytotoxic subset of CD4+ T cells, their differentiation and function. Front Immunol, 2017, 8: 194.
14.	Wong CK, Lam CWK, Wu AKL, et al. Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol, 2004, 136(1): 95-103.
15.	Liu J, Li SM, Liu J, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine, 2020, 55: 102763.
16.	He SS, Zhou C, Lu DQ, et al. Relationship between Chest CT manifestations and immune response in COVID-19 patients[J/OL]. Int J Infect Dis, 2020, [2020-06-20]. https://doi.org/10.1016/j.ijid.2020.06.059.
17.	Yarza R, Bover M, Paredes D, et al. SARS-CoV-2 infection in cancer patients undergoing active treatment: analysis of clinical features and predictive factors for severe respiratory failure and death[J/OL]. Eur J Cancer, [2020-06-06]. https://doi.org/10.1016/j.ejca.2020.06.001.
18.	Jin X, Lian JS, Hu JH, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut, 2020, 69(6): 1002-1009.
19.	Huang CL, Wang YM, Li XW, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
20.	Song ZQ, Xu YF, Bao LL, et al. From SARS to MERS, thrusting coronaviruses into the spotlight. Viruses, 2019, 11(1): 59.
21.	Yin YD, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology, 2018, 23(2): 130-137.

1. Vetter P, Vu DL, L'Huillier AG, et al. Clinical features of covid-19. BMJ, 2020, 369: m1470.
2. 中华人民共和国国家卫生健康委员会办公厅. 新型冠状病毒感染的肺炎诊疗方案(试行第七版)[EB/OL]. [2020-03-04](2020-03-15).
3. Jonsdottir HR, Dijkman R. Coronaviruses and the human airway: a universal system for virus-host interaction studies. Virol J, 2016, 13: 24.
4. Arabi YM, Alothman A, Balkhy HH, et al. Treatment of Middle East respiratory syndrome with a combination of lopinavir- ritonavir and interferon-β1b (MIRACLE trial): study protocol for a randomized controlled trial. Trials, 2018, 19(1): 81.
5. Lansbury L, Rodrigo C, Leonardi-Bee J, et al. Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev, 2019, 2(2): CD010406.
6. Wang YP, Liao BL, Guo Y, et al. Clinical characteristics of patients infected with the novel 2019 coronavirus (SARS-Cov-2) in Guangzhou, China. Open Forum Infect Dis, 2020, 7(6): ofaa187.
7. Huang DZ, Lian XJ, Song FE, et al. Clinical features of severe patients infected with 2019 novel coronavirus: a systematic review and meta-analysis. Ann Transl Med, 2020, 8(9): 576.
8. Suleyman G, Fadel RA, Malette KM, et al. Clinical characteristics and morbidity associated with coronavirus disease 2019 in a series of patients in Metropolitan Detroit. JAMA Netw Open, 2020, 3(6): e2012270.
9. Badawi A, Ryoo SG. Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. Int J Infect Dis, 2016, 49: 129-133.
10. Channappanavar R, Fett C, Mack M, et al. Sex-based differences in susceptibility to severe acute respiratory syndrome coronavirus infection. J Immunol, 2017, 198(10): 4046-4053.
11. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med, 2020, 382(18): 1708-1720.
12. Zheng CC, Wang JQ, Guo H, et al. Risk-adapted treatment strategy for COVID-19 patients. Int J Infect Dis, 2020, 94: 74-77.
13. Takeuchi A, Saito T. CD4 CTL, a cytotoxic subset of CD4+ T cells, their differentiation and function. Front Immunol, 2017, 8: 194.
14. Wong CK, Lam CWK, Wu AKL, et al. Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol, 2004, 136(1): 95-103.
15. Liu J, Li SM, Liu J, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine, 2020, 55: 102763.
16. He SS, Zhou C, Lu DQ, et al. Relationship between Chest CT manifestations and immune response in COVID-19 patients[J/OL]. Int J Infect Dis, 2020, [2020-06-20]. https://doi.org/10.1016/j.ijid.2020.06.059.
17. Yarza R, Bover M, Paredes D, et al. SARS-CoV-2 infection in cancer patients undergoing active treatment: analysis of clinical features and predictive factors for severe respiratory failure and death[J/OL]. Eur J Cancer, [2020-06-06]. https://doi.org/10.1016/j.ejca.2020.06.001.
18. Jin X, Lian JS, Hu JH, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut, 2020, 69(6): 1002-1009.
19. Huang CL, Wang YM, Li XW, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
20. Song ZQ, Xu YF, Bao LL, et al. From SARS to MERS, thrusting coronaviruses into the spotlight. Viruses, 2019, 11(1): 59.
21. Yin YD, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology, 2018, 23(2): 130-137.

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