Study identifies characteristics of patients with fatal COVID-19

Summary: Based on data from COVID-19 patients from Wuhan, China, that died as a result of the infection, researchers have identified many symptom commonalities the patients shared.

Source: American Thoracic Society

In a new study, researchers identified the most common characteristics of 85 COVID-19 patients who died in Wuhan, China in the early stages of the coronavirus pandemic. The study reports on commonalities of the largest group of coronavirus patient deaths to be studied to date. The paper was published online in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

In “Clinical Features of 85 Fatal Cases of COVID-19 From Wuhan: A Retrospective Observational Study,” researchers from China and the United States report on an analysis of the electronic health records of patients with COVID-19 who died despite treatment at two hospitals in Wuhan: Hanan Hospital and Wuhan Union Hospital between Jan. 9 and Feb. 15, 2020. Wuhan, in China’s Hubei Province, was the epicenter of the COVID-19 outbreak.

“The greatest number of deaths in our cohort were in males over 50 with non-communicable chronic diseases,” stated the authors. “We hope that this study conveys the seriousness of COVID-19 and emphasizes the risk groups of males over 50 with chronic comorbid conditions including hypertension (high blood pressure), coronary heart disease and diabetes.”

The researchers examined the medical records of 85 patients who had died, and recorded information on their medical histories, exposures to coronavirus, additional chronic diseases they had (comorbidities), symptoms, laboratory findings, CT scan results and clinical management. Statistical analyses were then done.

The median age of these patients was 65.8, and 72.9 percent were men. Their most common symptoms were fever, shortness of breath (dyspnea) and fatigue.

Hypertension, diabetes and coronary heart disease were the most common comorbidities. A little over 80 0 percent of patients had very low counts of eosinophils (cells that are reduced in severe respiratory infections) on admission. Complications included respiratory failure, shock, acute respiratory distress syndrome (ARDS) and cardiac arrhythmia, among others. Most patients received antibiotics, antivirals and glucocorticoids (types of steroids). Some were given intravenous immunoglobulin or interferon alpha-2b.

The researchers noted: “The effectiveness of medications such as antivirals or immunosuppressive agents against COVID-19 is not completely known. Perhaps our most significant observation is that while respiratory symptoms may not develop until a week after presentation, once they do there can be a rapid decline, as indicated by the short duration between time of admission and death (6.35 days on average) in our study.”

Based on their findings, eosinophilopenia – abnormally low levels of eosinophils in the blood – may indicate a poor prognosis. The scientists also noted that the early onset of shortness of breath may be used as an observational symptom for COVID-19 symptoms. In addition, they noted that a combination of antimicrobial drugs (antivirals, antibiotics) did not significantly help these patients. The majority of patients studied died from multiple organ failure.

This shows a doctor and the virus
The median age of these patients was 65.8, and 72.9 percent were men. Their most common symptoms were fever, shortness of breath (dyspnea) and fatigue. The image is in the public domain.

“Our study, which investigated patients from Wuhan, China who died in the early phases of this pandemic, identified certain characteristics. As the disease has spread to other regions, the observations from these areas may be the same, or different. Genetics may play a role in the response to the infection, and the course of the pandemic may change as the virus mutates as well. Since this is a new pandemic that is constantly shifting, we think the medical community needs to keep an open mind as more and more studies are conducted.”

The study authors are affiliated with a number of medical centers and departments of the Chinese PLA General Hospital; Wuhan Union Hospital; Renmin Hospital of Wuhan University; China’s National Clinical Research Center for Geriatric Diseases; Wuhan Hannan Hospital; Tongji Medical College, Huazhong University of Science & Technology; Joe DiMaggio Children’s Hospital, Hollywood, FL; and University of California, Davis.

About this coronavirus research article

Source:
American Thoracic Society
Media Contacts:
Dacia Morris – American Thoracic Society
Image Source:
The image is in the public domain.

Original Research: Open access
“Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan: A Retrospective Observational Study”. Yingzhen Du, Lei Tu Pingjun Zhu, Mi Mu, Runsheng Wang, Pengcheng Yang, Xi Wang, Chao Hu, Rongyu Ping, Peng Hu, Tianzhi Li, Feng Cao, Christopher Chang; Qinyong Hu; Yang Jin, and Guogang Xu.
American Journal of Respiratory and Critical Care Medicine doi:10.1164/rccm.202003-0543OC .

Abstract

Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan: A Retrospective Observational Study

Background: The global death toll from COVID-19 virus exceeds 21000. The risk factors for death were attributed to advanced age and co-morbidities, but haven’t been accurately defined. Objectives: To report the clinical features of 85 fatal cases with COVID-19 in two hospitals in Wuhan.

Method: Medical records of 85 fatal cases of COVID-19 between January 9 and February 15, 2020 were collected. Information recorded included medical history, exposure history, comorbidities, symptoms, laboratory findings, CT scans and clinical management. Measurements and Main

Results: The median age of the patients was 65.8 years and 72.9% were male. Common symptoms were fever (78 [91.8%]), shortness of breath (50 [58.8%]), fatigue (50 [58.8%]), dyspnea (60 [70.6%]). Hypertension, diabetes and coronary heart disease were the most common comorbidities. Notably, 81.2% patients had very low eosinophil counts at admission. Complications included respiratory failure (80 [94.1%]), shock (69 [81.2%]), ARDS (63 [74.1%]), arrhythmia (51 [60%]), etc. Most patients received antibiotic (77 [90.6%]), antiviral (78 [91.8%]) and glucocorticoids (65 [76.5%]) treatments. 38 patients [44.7%] and 33 [38.8%] received intravenous immunoglobulin and interferon α2b respectively.

Conclusions: In this depictive study of 85 fatal cases of COVID-19, most cases were male aged over 50 years old with noncommunicable chronic diseases. The majority of the patients died of multiple organ failure. Early onset of shortness of breath may be used as an observational symptom for COVID-19 exacerbations. Eosinophilopenia may indicate a poor prognosis. The combination of anti-microbial drugs did not offer considerable benefit to the outcome of this group of patients.

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