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dcyphr | Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

Abstract

This is a retrospective study revealing mortality information about 52 critically ill

adult patients diagnosed with SARS-CoV-2 in Wuhan Jin Yin-tan hospital. Symptom, laboratory, comorbidity and outcome data was gathered about these ICU patients. Overall findings noted significant mortality for ill individuals over 65 years of age and a frequent need for mechanical respiration.


Introduction 

The initial spread of the now global SARS-CoV-2 virus was traced back to areas around Wuhan, China. This is one of the earliest studies presenting data of cases in this region, aiming to improve outcome information available to healthcare professionals. The retrospective nature of the study allowed researchers to collect mortality data and to observe survivors follow-up. 


Methods

The Wuhan Jin Yin-tan hospital was used as the data source for this study, as it was a designated treatment center for SARS-CoV-2 in the region. 52 critically ill patients (deemed “critical” based on ICU admission, need for mechanical ventilation, or low inspired oxygen levels) admitted between Dec 24, 2019 and Jan 26, 2020 were observed. 

Age, sex, exposure history, chronic illness history, lab data, and various in-hospital symptoms (cough, fever, headache, chest pain…) were all collected and evaluated. Certain details such as ventilator settings could not be recorded due to the emergency nature of some provisional ICU’s. Primary outcome was 28-day mortality following a patient’s ICU admission, secondary outcomes were incidence of acute respiratory distress syndrome (ARDS, fluid build up in alveoli) and the need for mechanical ventilation. 

Mean age of patients was 59.7, with 67% being men. 33% of patients had known exposure to the Huanan seafood market and 40% had known chronic illnesses. 

Results

98% of patients experienced fever (most common symptom), 77% experienced cough and 63.5% displayed labored breathing (dyspnoea). Some patients took 2-8 days to develop a fever after showing other initial symptoms. The time between the onset of symptoms and pneumonia confirmation (via radiology) was 5 days. 

Organ function damage was prevalent , with 67% developing ARDS, 29% suffering from kidney injury, 23% experiencing cardiac problems, and 29% having liver issues. Some (13%) patients also developed hospital acquired infection.

Treatment was mainly supportive care, including high-flow nasal cannula  (oxygen supplementation), mechanical ventilation (required by 71% of patients), antiviral agents, antibacterial agents, glucocorticoids (immunosuppression), and others.

61.5% of patients died within the 28 day time frame established by the study. An average of 7 days elapsed from ICU admission to death in nonsurvivors. Only 8 of 20 surviving patients were discharged within the 28 days (the rest requiring continued care). Nonsurvivors tended to be older (average of 64.6 years) and to have chronic illnesses (53% had known conditions). Nonsurvivors were also more likely to develop ARDS and to require mechanical ventilation. 


Discussion 

The high mortality rate presented by this study is consistent with prior coronaviruses, but higher than SARS of MERS. This higher mortality can be connected to the prevalence of severe ARDS in severe pneumonia patients. It is notable that 70% of patients infected with SARS-CoV-2 were men (based on previous studies) and that nonsurvivors tended to be older relative to survivors. Additionally, over 80% of patients in this study displayed abnormally low blood lymphocyte levels (a consequence of SARS-CoV-2’s damaging effect on patient’s lymphocytes).