Preprints with The Lancet published the results of the team’s research at Concord Hospital in Wuhan on March 3, local time, “Clinical Drais of Deceased Patients Infected Wi th SARS-CoV-2 in Wuhan, China” analyzed the epidemiological and clinical characteristics of 65 deaths from new coronary disease, revealing some of the factors associated with the risk of death from the disease.
The research team came from Wuhan Huazhong University of Science and Technology Tongji Medical College affiliated Concord Hospital, Wuhan Red Cross Hospital, Harvard Medical School McLean Hospital and other institutions, the author of the article is McLean Hospital Psychoneurogenomics Laboratory Director Lin Zhicheng, Wuhan Concord Hospital Deputy Director of Neurology Dr. Xiong Nian.
This is the first time a team has studied and analyzed the epidemiological and clinical characteristics of deaths from the new coronavirus infection (COVID-19) in 2019. The team found an increase in mortality in patients with advanced age (especially over 60 years of age) and more underlying diseases. The leading causes of death include respiratory failure, circulatory failure, and multiple organ failure.
In addition, they believe that the levels of CK (creatine kinase), LDH (lactic acid dehydrogenase) and infection-related biomarkers (including CRP levels) in the patient’s serum increased significantly or could be an important indicator of the prognosis of COVID-19.
Previous studies have shown that the patient mortality rate (CFR) for COVID-19 has decreased as the number of infections increases, while patients in Hubei Province have higher CFR than other parts of China (14.97% vs. 0.52%). But there has been no previous study to explore why mortality rates are high in Hubei province, and the authors believe that comparing deaths with those who survive may help identify the main causes and risk factors for new coronary disease-related deaths and better treat mild cases, thereby reducing mortality in PATIENTs with COVID-19.
The paper collected data from two groups of patients, from 21 January to 14 February 2020, in 65 patients with confirmed COVID-19 patients admitted to the Red Cross Hospital of Wuhan City and 96 surviving patients (control group), and analyzed their epidemiology, demography, clinical, laboratory, Radiology and other characteristics and treatment data.
All patients undergo laboratory diagnosis and chest CT scans, including treatment, antiviral therapy, glucocorticoid therapy, and respiratory support.
The results showed that the median age of 65 patients who died was 67 years (range 31-87 years), of which 52 (80%) were over 60 years of age, while men were the majority (42 cases, 65%). By comparison, the median age of the surviving patients was 46 years (range 22-87 years).
Of the 171 patients in both groups, only one died. 17% (29 out of 171 patients) were between the ages of 40 and 49, and 4 of them died. Patients aged 50-59 accounted for 14 per cent of the survival group and 12 per cent of the death group.
Age and gender of dead and surviving patients
The most common combined health problems in patients who died were cardiovascular (39,60%) and endocrine system (21,43%) diseases. The common symptoms at the time of their onset were breathing difficulties (65,100%), fever (59,91%), fatigue (56,86%), anorexia (54,86%) and cough (42,65%), all of which occurred more often than those who survived.
There were also many differences in laboratory test results between the death and survivor groups. Forty-two percent (27) of the 65 deaths showed white blood cell growth (white blood cell count exceeds 10 x 109 / L), while 31 percent of the 96 survivors (30 cases) had leukocyte reduction (white blood cell count less than 4 x 109 / L) and only 8 percent of the dead had leukocyte reduction.
The median percentage of neutrophils in dead patients was 90.3% (range 47.5-97.9%), while the median percentage of neutrophils in the surviving patients was 61.3% (range 33.5-94.7%). The average percentage of lymphocytes in the dead group at the time of the onset of symptoms was lower than the percentage of surviving groups.
Blood routine, blood biochemistry, and biomarker examination associated with infection in dead and surviving patients
The time of coagulation enzyme (PT), activated partial clotting enzyme time (APTT) and D-dipolymer levels (3.28 mg/L vs. 0.35 mg/L) were all higher than when hospitalized in deceased patients.
The average number of patients who died were higher than those who survived, with urea nitrogen, creatinine, CK (creatine kinase) and LDH (lactic acid dehydrogenase). In 60 of the 65 deaths (92%) the average levels of athysininaina (AST) and alanine amino transferase (ALT) were high, but fewer than 30% of the surviving patients had similar AST and ALT levels. Infection-related biomarkers, including CRP (C-reactive protein, which occurs when the patient’s body is subjected to inflammatory stimuli such as microbial invasion or tissue damage) also differ significantly between the dead and the surviving patients.
Of the 65 deaths, 64 (98%) had at least one combined disease, including 31 cases of acute respiratory injury (48%), 27 cases of ARDS (acute respiratory distress syndrome), 3 cases of acute heart injury (5%), 2 cases of acute kidney injury (3%), and 1 case of infectious shock (2%). By contrast, only one of the 96 surviving patients had ARDS (1%).
All patients had abnormalities in CT images, with more patients who died of bronchitis, biphenyl pneumonia, multiple lung activity, and glass-like turbidity than survivors (P?lt;0.0001).
In clinical treatment, 65 patients who died all received high-flow oxygen absorption and 16 (25%) received noninvasive ventilation. In both the death and survival groups, the majority of patients received antiviral therapy (oseltamivir, Abido and penicillovir), antibacterial therapy (moxisacin, cephalosporine, azithromycin) and intravenous immunoglobulin therapy (IVIG).
More patients in the death group received systemic glucocorticoid therapy than survivors (46 (71%)vs. 29 (30%);P and ;P and 0.0001. In addition, in 2 of the 65 deaths (3%) of the cases, the in vitro membrane pulmonary oxygenation technology (ECMO) was used, 1 (2%) used continuous renal replacement therapy (CRRT), and 96 surviving patients did not use the above treatment.
Comorbidity, chest CT and treatment of dead and surviving patients
As of February 14, 2020, a total of 36 patients in the study sample were discharged from the hospital, with an average of 12.5 days (minimum 3 days, a maximum of 28 days) and other patients remaining in the hospital.
The authors say the leading causes of death are acute respiratory injury and acute respiratory distress syndrome, a risk factor of age and underlying disease, and the majority of deaths are of one or more comorbidities.
In addition, laboratory indicators showed a significant increase in the level of PT/APTT/D-dypolymer in the blood after infection, indicating that the circulatory system was in a state of high condensation, which could easily lead to pulmonary embolism. It is worth noting that elevated levels of D-dipolymer and FDP (fibrinoprogen degradation product) in PATIENTs with COVID-19 were associated with poor prognosis in patients.
The authors also found that elevated CK (creatine kinase), LDH (lactic acid dehydrogenase) and CRP (C reactive protein) levels could be potential markers of COVID-19 prognosis. It has previously been reported that CK is related to the prognosis of patients with non-muscle-soaked nipple-like urinary maltosin (UTUC).
Previous studies have also found that LDH levels may pose a potential risk in patients with metastatic germ cell tumors or indicate clinical outcomes in patients with advanced bile duct cancer.
In addition, the researchers found that elevated levels of inflammatory factors, such as CRP, could also lead to death.
At the end of the paper, the authors say that COVID-19 prevention and early diagnosis seem to be more important to older people than younger people.
Taking into account the possible results of the false negative RT-PCR (reverse transcription polymerase chain reaction), the authors suggest that chest CT scans may also be an effective screening tool. At the same time, the authors recommend that patients be tested for viral serum (IgM, IgG) if necessary, which is more sensitive than RT-PCR testing.
The researchers say asymptomatic infections ( usually among young people ) are highly likely to be a potential source of infection because of their susceptibility to the new coronavirus. Therefore, disease prevention, early detection and isolation in mild patients are essential for controlling the disease.