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Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1091 (Published 26 March 2020) Cite this as: BMJ 2020;368:m1091

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  1. Tao Chen, doctor1,
  2. Di Wu, doctor1,
  3. Huilong Chen, doctor1,
  4. Weiming Yan, research associate1,
  5. Danlei Yang, doctor2,
  6. Guang Chen, doctor1,
  7. Ke Ma, doctor1,
  8. Dong Xu, doctor1,
  9. Haijing Yu, doctor1,
  10. Hongwu Wang, doctor1,
  11. Tao Wang, doctor2,
  12. Wei Guo, doctor1,
  13. Jia Chen, doctor1,
  14. Chen Ding, doctor1,
  15. Xiaoping Zhang, doctor1,
  16. Jiaquan Huang, doctor1,
  17. Meifang Han, doctor1,
  18. Shusheng Li, doctor3,
  19. Xiaoping Luo, doctor4,
  20. Jianping Zhao, doctor2,
  21. Qin Ning, doctor1
  1. 1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  2. 2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  3. 3Department of Emergency Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
  4. 4Department of Paediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  1. Correspondence to: Q Ning qning{at}vip.sina.com
  • Accepted 17 March 2020

Abstract

Objective To delineate the clinical characteristics of patients with coronavirus disease 2019 (covid-19) who died.

Design Retrospective case series.

Setting Tongji Hospital in Wuhan, China.

Participants Among a cohort of 799 patients, 113 who died and 161 who recovered with a diagnosis of covid-19 were analysed. Data were collected until 28 February 2020.

Main outcome measures Clinical characteristics and laboratory findings were obtained from electronic medical records with data collection forms.

Results The median age of deceased patients (68 years) was significantly older than recovered patients (51 years). Male sex was more predominant in deceased patients (83; 73%) than in recovered patients (88; 55%). Chronic hypertension and other cardiovascular comorbidities were more frequent among deceased patients (54 (48%) and 16 (14%)) than recovered patients (39 (24%) and 7 (4%)). Dyspnoea, chest tightness, and disorder of consciousness were more common in deceased patients (70 (62%), 55 (49%), and 25 (22%)) than in recovered patients (50 (31%), 48 (30%), and 1 (1%)). The median time from disease onset to death in deceased patients was 16 (interquartile range 12.0-20.0) days. Leukocytosis was present in 56 (50%) patients who died and 6 (4%) who recovered, and lymphopenia was present in 103 (91%) and 76 (47%) respectively. Concentrations of alanine aminotransferase, aspartate aminotransferase, creatinine, creatine kinase, lactate dehydrogenase, cardiac troponin I, N-terminal pro-brain natriuretic peptide, and D-dimer were markedly higher in deceased patients than in recovered patients. Common complications observed more frequently in deceased patients included acute respiratory distress syndrome (113; 100%), type I respiratory failure (18/35; 51%), sepsis (113; 100%), acute cardiac injury (72/94; 77%), heart failure (41/83; 49%), alkalosis (14/35; 40%), hyperkalaemia (42; 37%), acute kidney injury (28; 25%), and hypoxic encephalopathy (23; 20%). Patients with cardiovascular comorbidity were more likely to develop cardiac complications. Regardless of history of cardiovascular disease, acute cardiac injury and heart failure were more common in deceased patients.

Conclusion Severe acute respiratory syndrome coronavirus 2 infection can cause both pulmonary and systemic inflammation, leading to multi-organ dysfunction in patients at high risk. Acute respiratory distress syndrome and respiratory failure, sepsis, acute cardiac injury, and heart failure were the most common critical complications during exacerbation of covid-19.

Footnotes

  • Contributors: TC, DW, HLC, WMY, DLY, and GC contributed equally to this paper, as did KM, DX, HJY, HWW, and TW. QN designed the study, had full access to all data in the study, and takes responsibility for the integrity and accuracy of the data analysis. TC, DW, HC, WY, DY, and GC contributed to patient recruitment, data collection, data analysis, data interpretation, literature search, and writing of the manuscript. KM, DX, HY, HW, WG, JH, TW, and MH had roles in patient recruitment, data collection, and clinical management. JC, CD, XZ, SL, XL, and JZ had roles in the patient management, data collection, data analysis, and data interpretation. All authors contributed to data acquisition, data analysis, or data interpretation, and all reviewed and approved the final version of the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. QN is the guarantor.

  • Funding: This work was funded by grants from the Tongji Hospital for Pilot Scheme Project and partly supported by the Chinese National Thirteenth Five Years Project in Science and Technology (2017ZX10202201), National Commission of Health, People’s Republic of China. The research was designed, conducted, analysed, and interpreted by the authors entirely independently of the funding sources.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the Tongji Hospital for Pilot Scheme Project and the Chinese National Thirteenth Five Years Project in Science and Technology, National Commission of Health, People’s Republic of China, for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The case series was approved by the Institutional Review Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (TJ-C20200101). Written informed consent was waived owing to the rapid emergence of this infectious disease.

  • Data sharing: No additional data available.

  • Transparency declaration: The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Dissemination to participants and related patient and public communities: No study participants were involved in the preparation of this article. The results of the article will be summarised in media press releases from the Huazhong University of Science and Technology and presented at relevant conferences.

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