Clinical course and predictors of 60-day mortality in 239 critically ill patients with COVID-19: a multicenter retrospective study from Wuhan, China.
239 例危重新型冠状病毒肺炎患者的临床过程和 60 天死亡率的预测因素: 来自中国武汉的多中心回顾性研究。
- 作者列表："Xu J","Yang X","Yang L","Zou X","Wang Y","Wu Y","Zhou T","Yuan Y","Qi H","Fu S","Liu H","Xia J","Xu Z","Yu Y","Li R","Ouyang Y","Wang R","Ren L","Hu Y","Xu D","Zhao X","Yuan S","Zhang D","Shang Y
BACKGROUND:The global numbers of confirmed cases and deceased critically ill patients with COVID-19 are increasing. However, the clinical course, and the 60-day mortality and its predictors in critically ill patients have not been fully elucidated. The aim of this study is to identify the clinical course, and 60-day mortality and its predictors in critically ill patients with COVID-19. METHODS:Critically ill adult patients admitted to intensive care units (ICUs) from 3 hospitals in Wuhan, China, were included. Data on demographic information, preexisting comorbidities, laboratory findings at ICU admission, treatments, clinical outcomes, and results of SARS-CoV-2 RNA tests and of serum SARS-CoV-2 IgM were collected including the duration between symptom onset and negative conversion of SARS-CoV-2 RNA. RESULTS:Of 1748 patients with COVID-19, 239 (13.7%) critically ill patients were included. Complications included acute respiratory distress syndrome (ARDS) in 164 (68.6%) patients, coagulopathy in 150 (62.7%) patients, acute cardiac injury in 103 (43.1%) patients, and acute kidney injury (AKI) in 119 (49.8%) patients, which occurred 15.5 days, 17 days, 18.5 days, and 19 days after the symptom onset, respectively. The median duration of the negative conversion of SARS-CoV-2 RNA was 30 (range 6-81) days in 49 critically ill survivors that were identified. A total of 147 (61.5%) patients deceased by 60 days after ICU admission. The median duration between ICU admission and decease was 12 (range 3-36). Cox proportional-hazards regression analysis revealed that age older than 65 years, thrombocytopenia at ICU admission, ARDS, and AKI independently predicted the 60-day mortality. CONCLUSIONS:Severe complications are common and the 60-day mortality of critically ill patients with COVID-19 is considerably high. The duration of the negative conversion of SARS-CoV-2 RNA and its association with the severity of critically ill patients with COVID-19 should be seriously considered and further studied.
背景: 全球确诊病例和死亡的危重新型冠状病毒肺炎患者数量不断增加。然而，危重患者的临床病程、 60 天死亡率及其预测因素尚未完全阐明。本研究的目的是确定新型冠状病毒肺炎危重患者的临床病程、 60 天死亡率及其预测因素。 方法: 纳入中国武汉 3 家医院重症监护病房 (icu) 收治的危重成人患者。关于人口统计学信息、先前存在的合并症、ICU入院时的实验室检查结果、治疗、临床结局的数据，收集SARS-CoV-2 RNA检测结果和血清SARS-CoV-2 IgM检测结果，包括症状开始和SARS-CoV-2 RNA阴转之间的持续时间。 结果: 1748 例新型冠状病毒肺炎患者中，共纳入 239 例 (13.7%) 危重患者。并发症包括 164 例 (68.6%) 患者的急性呼吸窘迫综合征 (ARDS)，150 例 (62.7%) 患者的凝血功能障碍，103 例 (43.1%) 患者的急性心脏损伤，以及急性肾损伤 (AKI)。119 例 (49.8%) 患者发生 15.5 天、 17 天、 18.5 天，症状发作后 19 天。在确定的 49 例危重病幸存者中，SARS-CoV-2 RNA阴转的中位持续时间为 30 (范围 6-81) 天。共有 147 例 (61.5%) 患者在入住ICU后 60 天死亡。ICU入院和死亡之间的中位持续时间为 12 (范围 3-36)。Cox比例风险回归分析显示，年龄大于 65 岁、入住ICU时血小板减少、ARDS和AKI独立预测 60 天死亡率。 结论: 严重并发症是常见的，新型冠状病毒肺炎危重患者的 60 天死亡率相当高。应认真考虑和进一步研究SARS-CoV-2 RNA转阴的持续时间及其与新型冠状病毒肺炎危重患者严重程度的相关性。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.