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Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study

Our take —

As seen in other settings, COVID-19 patients who died were more likely than survivors to be male, to be older, to have pre-existing conditions, to present with dyspnea and oxygen saturation levels ≤93%, and to have elevated concentrations of inflammatory markers. Among those who died, acute cardiac injury and heart failure were common, while kidney and liver damage were less common. The markers of inflammation and other serologic parameters that differed between patients who died and survived may inform future research on prognostic markers.

Study design

Case Series

Study population and setting

Adults (median age: 62 years, 62% male) with moderate to critical laboratory-confirmed COVID-19 illness admitted to Tongji Hospital in Wuhan, China from January 13, 2020-February 12, 2020 who died (n=113) or recovered (n=161) by February 28, 2020.

Summary of Main Findings

Compared to inpatients who recovered, those who died were significantly older, more likely to be male, and more likely to have pre-existing comorbidities (63% vs. 39%), among which hypertension was most prevalent. Those who died were more likely than survivors to have experienced dyspnea and chest tightness at symptom onset, and to have more severe presentation at the time of admission/transfer, including disordered consciousness (22% vs. 1%) and percutaneous oxygen saturation levels ≤93% (64% vs. 12%). Median time from hospital admission/transfer to death was 5 days. Leukocytosis, lymphopenia, and elevated concentrations of markers of systemic inflammation were more prevalent among those who died than survived. Among those who died, complications included ARDS (100%), acute cardiac injury (77%), heart failure (49%), acute kidney injury (25%), and acute liver injury (9%). Among survivors, 52% had ARDS, 17% acute cardiac injury (37% among those with CVD comorbidities), and 1% acute kidney injury.

Study Strengths

The study population is well-characterized, with data on pre-existing morbidities, COVID-19 symptoms, treatments, complications of multiple organ systems, and numerous serologic markers.

Limitations

Data on prognostic factors from earlier in the course of disease are lacking, since the hospital is a referral center for severe disease. The study population excludes the majority of the patients admitted/referred during the study period, who had not yet died or fully recovered at the time of analysis, and whose characteristics and disease trajectory may differ from those included the analysis. Data were not stratified by disease severity at admission or adjusted for age or other characteristics which differ between the groups who died and survived.

Value added

This is one of the most comprehensive descriptive studies of the clinical course of severe COVID-19 disease, including detailed serologic parameters and a range of extrapulmonary complications, by survival status.