ObjectiveTo investigate the clinical characteristics and contribution factors in severe coronavirus disease 2019 (COVID-19).MethodsThe 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.ResultsThe 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%.ConclusionsOld 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.
Objective To describe the development trend of clinical symptoms, pulmonary function and chest imaging examination of COVID-19 discharged from Xinyang from January 2020 to June 2020, and analyze the related risk factors. Methods This study was a prospective, longitudinal and cohort study. The survivors of COVID-19 hospitalized in Xinyang Fifth People's Hospital and Xinyang Central Hospital from January to June, 2020 were prospectively followed up 12 months and 24 months after discharge. Patients who refused to participate in the study and suffered from cancer and chronic respiratory diseases, including asthma or chronic obstructive pulmonary disease, were excluded. During the follow-up period, the patients who meet the research conditions were asked about clinical symptoms, routine and biochemical blood tests, pulmonary function and chest high-resolution CT (HRCT) and 6-minute walking distance test, and were evaluated with the Dyspnea Scale (mMRC). Results It was found that from January to June, 2020, among 207 eligible patients, 169 patients participated in this study, including 126 cases of mild and ordinary type (74.6%) and 43 cases of severe and critical type (25.4%). There were 100 males (59.2%) and 69 females (40.8%), aged 20 - 78 years old (50±15). It was found that more than half of COVID-19 patients had one or more symptoms at the end of 12 months after rehabilitation, including fatigue (90 cases, 53.3%), insomnia (43 cases, 25.4%), anxiety (24 cases, 14.2%), chest tightness (29 cases, 17.2%) and alopecia (35 cases, 20.7%). Two years after discharge, 52 patients (30.8%) still had at least one clinical symptom. The quality of life, cardiopulmonary function and exercise ability of COVID-19 patients in rehabilitation period decreased to varying degrees. Most patients' lung function and CT results returned to normal, but a few patients still had persistent lung function and imaging abnormalities 12 months and 24 months after discharge. Pulmonary function was mainly manifested as diffuse function injury, and the predicted value of carbon monoxide diffusion capacity (DLCO) was less than 80% in 44 cases (26.0%). Pulmonary HRCT mainly showed chronic inflammation in one lung/both lungs (28 cases, 41.2%), multiple nodules in one lung/both lungs (23 cases, 33.8%) and ground glass shadow (10 cases, 14.7%), etc. Multivariate logistic regression analysis showed that female COVID-19 patients with old age were more likely to have anxiety symptoms after discharge, which had nothing to do with the severity of acute disease. Older female patients with severe COVID-19 were more likely to have symptoms of DLCO damage during the recovery period, and their lung function gradually recovered with time. Conclusions Most of COVID-19 patients in Xinyang recovered well during the rehabilitation period, but some patients still had clinical symptoms such as fatigue, insomnia, anxiety, etc. The absorption of lung lesions was slow and some patients were accompanied by impaired pulmonary diffusion function. With the extension of rehabilitation time, the above symptoms have been significantly improved.