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[Clinical characteristics and outcome of 64 patients with severe COVID-19].
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Aug 12; 43(8):659-664.ZJ

Abstract

Objective:

To investigate the causes of death in patients with severe COVID-19.

Methods:

A retrospective analysis was performed on 64 patients with severe COVID-19 admitted to Wuhan Pulmonary Hospital from January 12, 2020 to February 28, 2020. There were 36 males and 28 females, aging from 44 to 85 years[median 68 (62, 72)]. Fifty-two patients (81%) had underlying comorbidities. The patients were divided into the death group (n=40) and the survival group (n=24) according to the treatment outcomes. In the death group, 24 were male, and 16 were female, aging from 49 to 85 years [median 69 (62, 72)], with 31 cases (78%) complicated with underlying diseases. In the survival group, there were 12 males and 12 females, aging from 44 to 82 years[median 66 (61,73)], with 21 cases (88%) with comorbidities. Clinical data of the two groups were collected and compared, including general information, laboratory examinations, imaging features and treatments. For normally distributed data, independent group t test was used; otherwise, Mann Whitney test was used to compare the variables. χ(2) test and Fisher exact test was used when analyzing categorical variables.

Results:

The median of creatine kinase isozyme (CK-MB) in the death group was 19.0 (17.0,23.0) U/L, which was higher than that in the survival group 16.5 (13.5,19.6) U/L. The median level of cTnI in the death group was 0.03 (0.03, 0.07) μg/L, which was significantly higher than that in the survival group (0.02, 0.03) μg/L, with a statistically significant difference between the two groups (P=0.007). The concentration of myoglobin in the death group was 79.5 (28.7, 189.0) μg/L, which was higher than 33.1 (25.7, 54.5) μg/L in the survival group. The level of D-dimer in the death group was 2.0 (0.6, 5.2) mg/L, which was higher than 0.7 (0.4, 2.0) mg/L in the survival group. The LDH level of the death group was 465.0 (337.5,606.5) U/L, which was higher than that of the survibal group, 341.0 (284.0,430.0) U/L, the difference being statistically significant (P=0.006). The concentration of alanine aminotransferase in the death group was 40.0 (30.0, 48.0) U/L, which was higher than 32.5 (24.0, 40.8) U/L in the survival group, and the difference was statistically significant (P=0.047).Abnormal ECG was found in 16 cases (62%) in the death group, which was significantly higher than that in the survival group (29%), the difference being statistically significant (P=0.024) .The main causes of death were severe pneumonia with acute respiratory distress syndrome (ARDS, n=20), acute heart failure(n=9), atrial fibrillation(n=3) and multiple organ dysfunction syndrome (MODS, n=3).

Conclusions:

ARDS caused by severe pneumonia and acute heart failure and atrial fibrillation caused by acute viral myocarditis were the main causes of death in severe COVID-19 patients. Early prevention of myocardial injury and treatment of acute viral myocarditis complicated with disease progression may provide insights into treatment and reduction of mortality in patients with severe COVID-19.

Authors+Show Affiliations

Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.

Pub Type(s)

Journal Article

Language

chi

PubMed ID

32727177

Citation

Zhu, Q, et al. "[Clinical Characteristics and Outcome of 64 Patients With Severe COVID-19]." Zhonghua Jie He He Hu Xi Za Zhi = Zhonghua Jiehe He Huxi Zazhi = Chinese Journal of Tuberculosis and Respiratory Diseases, vol. 43, no. 8, 2020, pp. 659-664.
Zhu Q, Zhang W, Wang Q, et al. [Clinical characteristics and outcome of 64 patients with severe COVID-19]. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(8):659-664.
Zhu, Q., Zhang, W., Wang, Q., Liu, J. H., Wu, C. H., Luo, T., & Peng, P. (2020). [Clinical characteristics and outcome of 64 patients with severe COVID-19]. Zhonghua Jie He He Hu Xi Za Zhi = Zhonghua Jiehe He Huxi Zazhi = Chinese Journal of Tuberculosis and Respiratory Diseases, 43(8), 659-664. https://doi.org/10.3760/cma.j.cn112147-20200308-00275
Zhu Q, et al. [Clinical Characteristics and Outcome of 64 Patients With Severe COVID-19]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Aug 12;43(8):659-664. PubMed PMID: 32727177.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Clinical characteristics and outcome of 64 patients with severe COVID-19]. AU - Zhu,Q, AU - Zhang,W, AU - Wang,Q, AU - Liu,J H, AU - Wu,C H, AU - Luo,T, AU - Peng,P, PY - 2020/7/31/entrez PY - 2020/7/31/pubmed PY - 2020/8/4/medline KW - COVID-19 KW - Myocardial injury KW - Prognosis KW - Respiratory Distress Syndrome, Adult KW - Viral myocarditis SP - 659 EP - 664 JF - Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases JO - Zhonghua Jie He He Hu Xi Za Zhi VL - 43 IS - 8 N2 - Objective: To investigate the causes of death in patients with severe COVID-19. Methods: A retrospective analysis was performed on 64 patients with severe COVID-19 admitted to Wuhan Pulmonary Hospital from January 12, 2020 to February 28, 2020. There were 36 males and 28 females, aging from 44 to 85 years[median 68 (62, 72)]. Fifty-two patients (81%) had underlying comorbidities. The patients were divided into the death group (n=40) and the survival group (n=24) according to the treatment outcomes. In the death group, 24 were male, and 16 were female, aging from 49 to 85 years [median 69 (62, 72)], with 31 cases (78%) complicated with underlying diseases. In the survival group, there were 12 males and 12 females, aging from 44 to 82 years[median 66 (61,73)], with 21 cases (88%) with comorbidities. Clinical data of the two groups were collected and compared, including general information, laboratory examinations, imaging features and treatments. For normally distributed data, independent group t test was used; otherwise, Mann Whitney test was used to compare the variables. χ(2) test and Fisher exact test was used when analyzing categorical variables. Results: The median of creatine kinase isozyme (CK-MB) in the death group was 19.0 (17.0,23.0) U/L, which was higher than that in the survival group 16.5 (13.5,19.6) U/L. The median level of cTnI in the death group was 0.03 (0.03, 0.07) μg/L, which was significantly higher than that in the survival group (0.02, 0.03) μg/L, with a statistically significant difference between the two groups (P=0.007). The concentration of myoglobin in the death group was 79.5 (28.7, 189.0) μg/L, which was higher than 33.1 (25.7, 54.5) μg/L in the survival group. The level of D-dimer in the death group was 2.0 (0.6, 5.2) mg/L, which was higher than 0.7 (0.4, 2.0) mg/L in the survival group. The LDH level of the death group was 465.0 (337.5,606.5) U/L, which was higher than that of the survibal group, 341.0 (284.0,430.0) U/L, the difference being statistically significant (P=0.006). The concentration of alanine aminotransferase in the death group was 40.0 (30.0, 48.0) U/L, which was higher than 32.5 (24.0, 40.8) U/L in the survival group, and the difference was statistically significant (P=0.047).Abnormal ECG was found in 16 cases (62%) in the death group, which was significantly higher than that in the survival group (29%), the difference being statistically significant (P=0.024) .The main causes of death were severe pneumonia with acute respiratory distress syndrome (ARDS, n=20), acute heart failure(n=9), atrial fibrillation(n=3) and multiple organ dysfunction syndrome (MODS, n=3). Conclusions: ARDS caused by severe pneumonia and acute heart failure and atrial fibrillation caused by acute viral myocarditis were the main causes of death in severe COVID-19 patients. Early prevention of myocardial injury and treatment of acute viral myocarditis complicated with disease progression may provide insights into treatment and reduction of mortality in patients with severe COVID-19. SN - 1001-0939 UR - https://www.unboundmedicine.com/medline/citation/32727177/[Clinical_characteristics_and_outcome_of_64_patients_with_severe_COVID_19]_ L2 - https://antibodies.cancer.gov/detail/CPTC-CHKA-1 DB - PRIME DP - Unbound Medicine ER -