[Clinical and laboratory characteristics of 215 cases of coronavirus disease 2019 with different prognosis].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Dec; 32(12):1428-1433.ZW
To analyze the clinical and laboratory characteristics of coronavirus disease 2019 (COVID-19) patients with different prognosis, and to provide evidence for the diagnosis and treatment of COVID-19.
The clinical and laboratory characteristics of 215 cases of confirmed COVID-19 patients admitted in the First People's Hospital of Tianmen City from January 18 to March 10, 2020 were retrospectively analyzed, including blood cell indexes, inflammatory indexes [C-reactive protein (CRP) and procalcitonin (PCT)], liver function, cardiac function, renal function, blood coagulation function, electrolyte, chest CT scan, and 2019 novel coronavirus (2019-nCoV) nucleic acid tests. The differences of above indexes in the two groups were compared and analyzed. In addition, 55 patients with other viral pneumonia were selected as the control group who admitted to the hospital from August 1 to November 30, 2019. The changes of laboratory indexes of COVID-19 group and control group were observed.
In the 215 patients, 206 patients survived and 9 patients died. The average age of survival group was significantly lower than that in the death group, and the average length of hospital stay was significantly longer than the death group. (1) Clinical features: the proportion of underlying diseases in the death group was significantly higher than that in the survival group, such as dyspnea, sore throat, shiver, hypertension, diabetes, coronary heart disease, renal disease, and surgical history. There were no significant differences in other symptoms, signs and underlying diseases between the two group. (2) Laboratory test indexes of the two groups: in death group, white blood cell count [WBC (×109/L): 10.6 (4.0, 13.4) vs. 4.90 (3.92, 6.26)], neutrophils count [NEU (×109/L): 9.7 (3.4, 12.2) vs. 2.9 (2.1, 4.2)]; ratio of neutrophils to lymphocytes [NLR: 14.66 (5.19, 18.48) vs. 2.34 (1.47, 3.34)], CRP [mg/L: 130.21 (35.74, 210.86) vs. 17.90 (3.11, 50.23)], PCT [mg/L: 1.46 (0.45, 13.12) vs. 0.04 (0.02, 0.07)], lactate dehydrogenase [LDH (μmol×s-1×L-1): 4.80 (3.34, 7.37) vs. 3.77 (2.99, 5.12)], creatinine [Cr (μmol/L): 72.9 (69.6, 627.5) vs. 68.4 (55.5, 81.9)], D-dimer [mg/L: 0.86 (0.56, 3.32) vs. 0.39 (0.33, 0.58)], the area of ground glass opacity of chest CT scan [77.8% (7/9) vs. 35.0% (72/206)], the area of local patchy shadows [55.6% (5/9) vs. 17.5% (36/206)], the area of bilateral patchy shadows [100.0% (9/9) vs. 49.5% (102/206)] were significantly higher than those in survival group (all P < 0.01), lymphocyte count [LYM (×109/L): 0.6 (0.5, 0.8) vs. 1.3 (1.0, 1.6)], Na+ [mmol/L: 136.1 (131.0, 136.8) vs. 138.8 (136.5, 140.4)], Cl- [mmol/L: 97.7 (92.7, 100.9) vs. 102.7 (100.2, 104.3)], and carbon dioxide [CO2 (mmol/L): 23.0 (20.6, 28.5) vs. 29.2 (27.7, 30.9)] were significantly lower than those in survival group (all P < 0.05). (3) Laboratory test indicators in COVID-19 and control groups: in COVID-19 group, WBC, NEU, LYM, platelet count (PLT), coefficient of variation of red blood cell distribution width (RDW-CV), standard deviation of red blood cell distribution width (RDW-SD) and Cl- were significantly lower than those in control group, NLR, CRP, K+ and CO2 were significantly higher than those in control group.
The major early symptoms of COVID-19 are fever, cough, chest tightness and fatigue. Age and underlying disease may be the risk factors which affect the prognosis of patients with COVID-19. The laboratory indexes such as WBC, NEU, LYM, CRP, PCT, LDH and Cr between death group and survival group were significantly abnormal in the early stages of COVID-19, which would have important implications for the prognosis of patients with COVID-19. Meanwhile, laboratory test indexes, including WBC, NEU, LYM, PLT, RDW-CV, RDW-SD, CRP, Cl-, K+ and CO2, also have important value in the differential diagnosis between COVID-19 and other viral pneumonia.