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Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study.
Intensive Care Med. 2020 10; 46(10):1863-1872.IC

Abstract

PURPOSE

An ongoing outbreak of coronavirus disease 2019 (COVID-19) emerged in Wuhan since December 2019 and spread globally. However, information about critically ill patients with COVID-19 is still limited. We aimed to describe the clinical characteristics and outcomes of critically ill patients with COVID-19 and figure out the risk factors of mortality.

METHODS

We extracted data retrospectively regarding 733 critically ill adult patients with laboratory-confirmed COVID-19 from 19 hospitals in China through January 1 to February 29, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were collected. The primary outcome was 28-day mortality. Data were compared between survivors and non-survivors.

RESULTS

Of the 733 patients included in the study, the median (IQR) age was 65 (56-73) years and 256 (34.9%) were female. Among these patients, the median (IQR) APACHE II score was 10 (7 to 14) and 28-day mortality was 53.8%. Respiratory failure was the most common organ failure (597 [81.5%]), followed by shock (20%), thrombocytopenia (18.8%), central nervous system (8.6%) and renal dysfunction (8%). Multivariate Cox regression analysis showed that older age, malignancies, high APACHE II score, high D-dimer level, low PaO2/FiO2 level, high creatinine level, high hscTnI level and low albumin level were independent risk factors of 28-day mortality in critically ill patients with COVID-19.

CONCLUSION

In this case series of critically ill patients with COVID-19 who were admitted into the ICU, more than half patients died at day 28. The higher percentage of organ failure in these patients indicated a significant demand for critical care resources.

Authors+Show Affiliations

Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.Department of Critical Care Medicine, Wuhan Jin-Yintan Hospital, Wuhan, 430071, China.Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Critical Care Medicine, Union Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430022, China.Department of Infection Disease, Wuhan Pulmonary Hospital, Wuhan, China.Department of Critical Care Medicine, Shenzhen Third Hospital, Shenzhen, China.Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.Department of Critical Care Medicine, Huangshi Hospital of Chinese Medicine, Huangshi, 435000, China.Department of Critical Care Medicine, Huangshi Central Hospital, Huangshi, 435000, China.Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.Emergency Department, The 900th Hospital of Joint Service Corps of Chinese PLA, Fuzhou, 350025, China.Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, 225001, China.Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China. tongzhaohuicy@sina.com.Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China. haiboq2000@163.com.Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and, Chinese Academy of Medical Sciences, Beijing, 100730, China. dubin98@gmail.com.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32816098

Citation

Xie, Jianfeng, et al. "Clinical Characteristics and Outcomes of Critically Ill Patients With Novel Coronavirus Infectious Disease (COVID-19) in China: a Retrospective Multicenter Study." Intensive Care Medicine, vol. 46, no. 10, 2020, pp. 1863-1872.
Xie J, Wu W, Li S, et al. Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study. Intensive Care Med. 2020;46(10):1863-1872.
Xie, J., Wu, W., Li, S., Hu, Y., Hu, M., Li, J., Yang, Y., Huang, T., Zheng, K., Wang, Y., Kang, H., Huang, Y., Jiang, L., Zhang, W., Zhong, M., Sang, L., Zheng, X., Pan, C., Zheng, R., ... Du, B. (2020). Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study. Intensive Care Medicine, 46(10), 1863-1872. https://doi.org/10.1007/s00134-020-06211-2
Xie J, et al. Clinical Characteristics and Outcomes of Critically Ill Patients With Novel Coronavirus Infectious Disease (COVID-19) in China: a Retrospective Multicenter Study. Intensive Care Med. 2020;46(10):1863-1872. PubMed PMID: 32816098.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study. AU - Xie,Jianfeng, AU - Wu,Wenjuan, AU - Li,Shusheng, AU - Hu,Yu, AU - Hu,Ming, AU - Li,Jinxiu, AU - Yang,Yi, AU - Huang,Tingrong, AU - Zheng,Kun, AU - Wang,Yishan, AU - Kang,Hanyujie, AU - Huang,Yingzi, AU - Jiang,Li, AU - Zhang,Wei, AU - Zhong,Ming, AU - Sang,Ling, AU - Zheng,Xia, AU - Pan,Chun, AU - Zheng,Ruiqiang, AU - Li,Xuyan, AU - Tong,Zhaohui, AU - Qiu,Haibo, AU - Du,Bin, Y1 - 2020/08/20/ PY - 2020/04/28/received PY - 2020/08/04/accepted PY - 2020/8/21/pubmed PY - 2020/10/10/medline PY - 2020/8/21/entrez KW - COVID-19 KW - Critically ill KW - Mortality KW - Organ failure SP - 1863 EP - 1872 JF - Intensive care medicine JO - Intensive Care Med VL - 46 IS - 10 N2 - PURPOSE: An ongoing outbreak of coronavirus disease 2019 (COVID-19) emerged in Wuhan since December 2019 and spread globally. However, information about critically ill patients with COVID-19 is still limited. We aimed to describe the clinical characteristics and outcomes of critically ill patients with COVID-19 and figure out the risk factors of mortality. METHODS: We extracted data retrospectively regarding 733 critically ill adult patients with laboratory-confirmed COVID-19 from 19 hospitals in China through January 1 to February 29, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were collected. The primary outcome was 28-day mortality. Data were compared between survivors and non-survivors. RESULTS: Of the 733 patients included in the study, the median (IQR) age was 65 (56-73) years and 256 (34.9%) were female. Among these patients, the median (IQR) APACHE II score was 10 (7 to 14) and 28-day mortality was 53.8%. Respiratory failure was the most common organ failure (597 [81.5%]), followed by shock (20%), thrombocytopenia (18.8%), central nervous system (8.6%) and renal dysfunction (8%). Multivariate Cox regression analysis showed that older age, malignancies, high APACHE II score, high D-dimer level, low PaO2/FiO2 level, high creatinine level, high hscTnI level and low albumin level were independent risk factors of 28-day mortality in critically ill patients with COVID-19. CONCLUSION: In this case series of critically ill patients with COVID-19 who were admitted into the ICU, more than half patients died at day 28. The higher percentage of organ failure in these patients indicated a significant demand for critical care resources. SN - 1432-1238 UR - https://www.unboundmedicine.com/medline/citation/32816098/Clinical_characteristics_and_outcomes_of_critically_ill_patients_with_novel_coronavirus_infectious_disease__COVID_19__in_China:_a_retrospective_multicenter_study_ L2 - https://dx.doi.org/10.1007/s00134-020-06211-2 DB - PRIME DP - Unbound Medicine ER -