Basic Characteristics
Basic characteristics of the 107 patients (95 from Zhongnan and 12 from Xi-Shui) are shown in Table 1. There were 88 survivors and 19 non-survivors. Median age was 51 years (IQR, 36–65; range, 19–92 years), 57 (53.3%) were male. Median times from first symptoms to hospital admission, dyspnea, and ARDS were 7 days (IQR, 3.5-9), 5.5 days (IQR, 2-9.3), and 7.5 days (IQR, 4.3–11), respectively. Median length of hospital stay was 11 days (IQR, 7–15). In this cohort of 107 patients, hypertension (26 [24.3%]), cardiovascular disease (13 [12.1%]) and diabetes (11 [10.3%]) were the most common coexisting conditions. The most common symptoms at onset of illness were fever (104 [97.2%]), dry cough (67 [62.6%]), fatigue (69 [64.5%]), dyspnea (35 [32.7%]), anorexia (33[30.8%]) and myalgia (33[30.8%]). Less common symptoms were sore throat, headache, dizziness, abdominal pain, diarrhea, nausea, and vomiting. At hospital admission median respiratory rate was 20/minute [IQR, 19–21] and mean arterial pressure was 89 mmHg [IQR, 83–98].
Table 1
Basic Characteristics of COVID-19 Patients.
Characteristics | Total (n = 107) | Survivors (n = 88) | Non-survivors (n = 19) | P Value |
Age, years | 51.0(36.0–65.0) | 44.5(35.0-58.8) | 73.0(64.0–81.0) | < 0.001* |
Sex | | | | 0.003* |
Male | 57(53.3) | 41(46.6) | 16(84.2) | |
Female | 50(46.7) | 47(53.4) | 3(15.8) | |
Comorbidity | | | | |
Hypertension | 26(24.3) | 16(18.2) | 10(52.6) | 0.001* |
Cardiovascular disease | 13(12.1) | 6(6.8) | 7(36.8) | 0.002* |
Diabetes | 11(10.3) | 6(6.8) | 5(26.3) | 0.024* |
Chronic liver disease | 6(5.6) | 5(5.7) | 1(5.3) | 1.000 |
Cerebrovascular disease | 6(5.6) | 3(3.4) | 3(15.8) | 0.068 |
COPD | 3(2.8) | 2(2.3) | 1(5.3) | 0.447 |
Chronic kidney disease | 3(2.8) | 2(2.3) | 1(5.3) | 0.447 |
Symptoms and signs | | | | |
Fever | 104(97.2) | 85(96.6) | 19(100.0) | 1.000 |
Dry cough | 67(62.6) | 56(63.6) | 11(57.9) | 0.639 |
Fatigue | 69(64.5) | 55(62.5) | 14(73.7) | 0.356 |
Dyspnea | 35(32.7) | 20(22.7) | 15(78.9) | < 0.001* |
Anorexia | 33(30.8) | 25(28.4) | 8(42.1) | 0.241 |
Myalgia | 33(30.8) | 28(31.8) | 5(26.3) | 0.638 |
Pharyngalgia | 12(11.2) | 11(12.5) | 1(5.3) | 0.689 |
Headache | 7(6.5) | 7(8.0) | 0(0) | 0.348 |
Dizziness | 7(6.5) | 7(8.0) | 0(0) | 0.348 |
Diarrhea | 7(6.5) | 3(3.4) | 4(21.1) | 0.018* |
Nausea | 6(5.6) | 6(6.8) | 0(0) | 0.588 |
Vomiting | 3(2.8) | 2(2.3) | 1(5.3) | 0.447 |
Abdominal pain | 2(1.9) | 1(1.1) | 1(5.3) | 0.325 |
Onset of symptom to admission (d) | 7.0(3.5-9.0) | 7.0(3.0-9.8) | 6.0(4.0–7.0) | 0.405 |
Onset of symptom to dyspnea (d) | 5.5(2.0-9.3) | 7.0(3.3–10.8) | 4.0(1.8–7.5) | 0.103 |
Onset of symptom to ARDS (d) | 7.5(4.3–11.0) | 10.0(6.0–13.0) | 7.0(3.5-9.0) | 0.081 |
Length of hospital stay (d) | 11.0(7.0–15.0) | 10.5(7.0–14.0) | 14.0(6.0–17.0) | 0.561 |
Heart rate (bpm) | 86(75–96) | 85(75–96) | 90(78–100) | 0.240 |
Respiratory rate | 20(19–21) | 20(19–21) | 22(20–24) | 0.003* |
Mean arterial pressure (mmHg) | 89(83–98) | 88(83–96) | 95(89–101) | 0.019* |
Data expressed as median (IQR ) or N (%) |
Abbreviations: COPD, chronic obstructive pulmonary disease; ARDS, acute respiratory distress syndrome; bpm, beats per minute. |
Data are median (IQR), n (%). p values indicate differences between survivors and non-survivors. P < 0.05 was considered as significant. Vital signs including heart rate, respiratory rate and mean arterial pressure were collected at admission. |
In comparison to the 88 hospital survivors, the 19 non-survivors were significantly older (median age, 73 years [IQR, 64–81] vs 44.5 years [IQR, 35-58.8]; p < .001) and were predominantly male (16 [84.2%] vs 41 [46.6%]; p = .003). Non-survivors were more likely to have underlying comorbidities, including hypertension (10 [52.6%] vs 16 [18.2%]; P = .001) and other cardiovascular disease (7 [36.8%] vs 6 [6.8%]; P = .002). Compared with the survivors, non-survivors were more likely to report dyspnea (15[78.9%] vs 20 [22.7%]; P < .001) and diarrhea (4[21.1%] vs 3[3.4%]; P = .018) at presentation. At hospital admission respiratory rate was higher in survivors than in non-survivors (22 [IQR 20–24] vs 20 [19–21]; p = .003). Similarly, mean arterial pressure was higher in non-survivors than in survivors (95 mmHg [IQR 89–101] vs 88 mmHg [83–96]; P = .019).
Laboratory Values And Radiographic Findings
Laboratory values and radiographic findings at hospital admission are shown in Table 2. Lymphopenia (0.9 × 10⁹/L [0.7–1.2]) and prolonged prothrombin time (12.8[11.9–13.5]) at admission were prominent features. 90 (84.1%) patients showed multi-lobar involvement on initial radiographs. 105 (98.1%) patients showed bilateral involvement on chest CT scan during hospitalization. A representative CT scan is shown in Fig. 1. Compared with survivors, on admission non-survivors had higher neutrophil counts (5.4 × 10⁹/L[3.2–8.5] vs 2.8 × 10⁹/L [2-3.9], P༜0.001, lower platelet count (122 × 10⁹/L [83–178] vs 178 [139–207], P = 0.006) and higher D-dimer level (439 mg/L [202–1991] vs 191 mg/L [108–327], P = 0.003). Admission values of blood urea, creatinine, highly sensitive troponin I, serum creatine kinase, creatine kinase-MB, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase were also significantly higher in the non-survivors.
Table 2
Initial Laboratory Values and Radiographic Findings of COVID-19 Patients.
| Normal range | Total (n = 107) | Survivors (n = 88) | Non-survivors (n = 19) | P Value |
White blood cell count, × 10⁹/L | 3.5–9.5 | 4.6(3.7–6.1) | 4.4(3.4–5.8) | 6.7(4.6–10.3) | 0.004* |
Neutrophil count, × 10⁹/L | 1.8–6.3 | 3.1(2.1–4.7) | 2.8(2.0-3.9) | 5.4(3.2–8.5) | < 0.001* |
Lymphocyte count, × 10⁹/L | 1.1–3.2 | 0.9(0.7–1.2) | 0.9(0.7–1.3) | 0.8(0.5–1.1) | 0.121 |
Platelet count, × 10⁹/L | 125–350 | 175(129–200) | 178(139–207) | 122(83–178) | 0.006* |
Prothrombin time, s | 9.4–12.5 | 12.8(11.9–13.5) | 12.9(12.0-13.5) | 12.6(11.9–13.5) | 0.813 |
Activated partial thromboplastin time, s | 25.1–36.5 | 31.7(29.4–33.9) | 31.7(29.5–33.5) | 32.7(27.5–37.0) | 0.850 |
D-dimer, mg/L | 0-500 | 203(121–358) | 191(108–327) | 439(202–1991) | 0.003* |
Creatine kinase, U/L | < 171 | 90(54–138) | 86(53–121) | 142(87–325) | 0.022* |
Creatine kinase-MB, U/L | < 25 | 14(10–18) | 13(9–16) | 18(13–44) | 0.008* |
Lactate dehydrogenase, U/L | 125–243 | 236(176–369) | 227(171–329) | 456(254–588) | 0.010* |
Alanine aminotransferase, U/L | 9–50 | 23(16–39) | 22(15–34) | 47(22–66) | 0.002* |
Aspartate aminotransferase, U/L | 15–40 | 31(24–47) | 29(23–41) | 67(38–90) | < 0.001* |
Total bilirubin, mmol/L | 5–21 | 9.8(8.4–14.1) | 9.5(8.4–12.9) | 11.3(9.4–20.7) | 0.069 |
Blood urea nitrogen, mmol/l | 2.8–7.6 | 4.2(3.2–5.6) | 3.9(3.0-4.7) | 6.1(4.9–10.5) | < 0.001* |
Creatinine, µmol/L | 64–104 | 71(60–86) | 68(58–83) | 87(71–130) | < 0.001* |
Hypersensitive troponin I, > 26.2 pg/mL, No. (%) | < 26.2 | 6(5.6) | 1(1.1) | 5(26.3) | 0.001* |
Multilobar involvement on initial radiographs, No. (%) | NA | 90(84.1) | 73(83.0) | 17(89.5) | 0.731 |
Bilateral involvement on radiographs during hospitalization, No. (%) | NA | 105(98.1) | 86(97.7) | 19(100.0) | 1.000 |
Abbreviations: MB, muscle and brain type; NA, not available. |
Data are median (IQR), or n (%). P values indicate differences between survivors and non-survivors. P < 0.05 was considered as significant. Laboratory values and radiographic findings were collected at admission except that the bilateral involvement on radiographs was collected during hospitalization. |
Complications, Treatments And Outcome
Common complications included ARDS (28[26.2%]), shock (22 [20.6%]), AKI (14[13.1%]) and acute cardiac injury (12[11.2%]). Non-survivors were more likely to have one of these complications than survivors. Secondary infection was uncommon. Almost all patients received antiviral therapy (105 [98.1%]). Glucocorticoids were administered in 62 [57.9%] patients. Oxygen therapy was applied in (80 [74.8%] patients. In total, 20 patients required invasive mechanical ventilation. On day 1 of invasive mechanical ventilation, the median PaO2/FiO2 ratio was 103 (IQR 58–172) and the median APACHE II score was 25 (IQR 17–32). Three patients received extracorporeal membrane oxygenation (ECMO) therapy, Two of them survived and were discharged at day 26 and day 32, and one died due to sudden cardiac arrest after connection to the ECMO circuit. The causes of death included refractory ARDS (15 [78.9%]), septic shock (1 [5.3%]), sudden cardiac arrest (1 [5.3%]), hemorrhagic shock (1 [5.3%]) and acute myocardial infarction (1 [5.3%]).
Risk Factors Associated With Death For Covid-19
On univariate analysis, risk factors associated with death at hospital admission were older age, male gender, hypertension, diabetes, cardiovascular disease, raised white blood cell counts, elevated level of neutrophil counts, thrombocytopenia, creatine kinase-MB, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase and creatinine (Table 3). On multivariable analysis, older age and male gender remained significant independent risk factors for death (Table 4).
Table 3
Univariate Analysis of Variable Associated With Death For COVID-19 Patients.
Variable | Univariable |
OR (95% CI) | P Value |
Age | 1.102(1.054–1.152) | < 0.001* |
Male | 6.114(1.662–22.485) | 0.006* |
Hypertension | 5.000(1.748–14.301) | 0.003* |
Diabetes | 4.881(1.310-18.184) | 0.018* |
Cardiovascular disease | 7.972(2.290-27.753) | 0.001* |
White blood cell count | 1.239(1.055–1.455) | 0.009* |
Neutrophil count | 1.257(1.073–1.472) | 0.005* |
Lymphocyte count | 0.234(0.051–1.075) | 0.062 |
Platelet count | 0.987(0.977–0.997) | 0.009* |
Prothrombin time | 1.084(0.737–1.595) | 0.683 |
Activated partial thromboplastin time | 0.998(0.979–1.017) | 0.829 |
Creatine kinase | 1.001(0.999–1.002) | 0.277 |
Creatine kinase-MB | 1.043(1.008–1.079) | 0.015* |
Lactate dehydrogenase | 1.006(1.002–1.010) | 0.004* |
Alanine aminotransferase | 1.020(1.002–1.038) | 0.031* |
Aspartate aminotransferase | 1.034(1.015–1.054) | < 0.001* |
Total bilirubin | 1.070(0.995–1.149) | 0.066 |
Blood urea nitrogen | 1.001(0.985–1.016) | 0.943 |
Creatinine | 1.037(1.015–1.058) | 0.001* |
Abbreviations: MB, muscle and brain type. |
P < 0.05 was considered as significant and labeled with an asterisk (*) at the top corner of the P value. |
Table 4
Univariate and Multivariate Analysis of Risk Factors Associated With Death (19 patients.
Variable | Univariable | Multivariable |
OR (95% CI) | P Value | OR (95% CI) | P Value |
Age (years) | 1.102(1.054–1.152) | < 0.001* | 1.111(1.042–1.184) | 0.001* |
Male | 6.114(1.662–22.485) | 0.006* | 7.224(1.298–40.190) | 0.024* |
Hypertension | 5.000(1.748–14.301) | 0.003* | 1.099(0.264–4.580) | 0.897 |
Cardiovascular disease | 7.972(2.290-27.753) | 0.001* | 1.188(0.182–7.765) | 0.857 |
Creatinine concentration | 1.037(1.015–1.058) | 0.001* | 1.012(0.987–1.037) | 0.342 |
P < 0.05 was considered as significant and labeled with an asterisk (*) at the top corner of the P value. |