Clinical Characteristics and Predictors of Disease Progression in Severe Patients with COVID-19 Infection in Jiangsu Province, China: A Descriptive Study

Mao Huang; Yi Yang; Futai Shang; Yishan Zheng; Wenjing Zhao; Liang Luo; Xudong Han; Aihua Lin; Hongsheng Zhao; Qing Gu; Yi Shi; Jun Li; Xingxiang Xu; Kexi Liu; YiJun Deng; Quan Cao; Weiwei Wang

doi:10.1016/j.amjms.2020.05.038

Clinical Characteristics and Predictors of Disease Progression in Severe Patients with COVID-19 Infection in Jiangsu Province, China: A Descriptive Study

Am J Med Sci. 2020 Aug;360(2):120-128. doi: 10.1016/j.amjms.2020.05.038. Epub 2020 Jun 1.

Authors

Mao Huang¹, Yi Yang², Futai Shang³, Yishan Zheng⁴, Wenjing Zhao⁵, Liang Luo⁶, Xudong Han⁷, Aihua Lin⁸, Hongsheng Zhao⁹, Qing Gu¹⁰, Yi Shi¹¹, Jun Li¹², Xingxiang Xu¹³, Kexi Liu¹⁴, YiJun Deng¹⁵, Quan Cao¹⁶, Weiwei Wang¹⁷

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
² Department of Critical Care Medicine, Zhongda Hospital of Southeast University, Nanjing, China.
³ Department of Critical Care Medicine, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China.
⁴ Department of Critical Care Medicine, Nanjing No.2 Hospital, Nanjing, China.
⁵ Department of Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
⁶ Department of Critical Care Medicine, Wuxi No. 2 People's Hospital, Wuxi, China.
⁷ Department of Critical Care Medicine, the Third People's Hospital of Nantong City, Affiliated to Nantong University, Nantong, China.
⁸ Department of Critical Care Medicine, Suqian People's Hospital of Nanjing Gulou Hospital Group, Suqian, China.
⁹ Department of Critical Care Medicine, the Affiliated Hospital of Nantong University, Nantong, China.
¹⁰ Department of Critical Care Medicine, Nanjing Drum Tower Hospital, the Affiliated of Nanjing University Medical School, Nanjing, China.
¹¹ Department of Pulmonary and Critical Care Medicine, Nanjing Jinlin Hospital, Nanjing, China.
¹² Department of Infectious Diseases, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
¹³ Department of Pulmonary and Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, China.
¹⁴ Department of Critical Care Medicine, Lianyungang First People's Hospital, Lianyungang, China.
¹⁵ Department of Critical Care Medicine, Yancheng First People's Hospital, Yancheng, China.
¹⁶ Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Electronic address: 2004caoquan@163.com.
¹⁷ Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Electronic address: wangweiwei199203@163.com.

Abstract

Background: We studied patients with coronavirus disease 2019 (COVID-19) infected by severe acute respiratory syndrome coronavirus 2, a virus that originated in Wuhan, China, and is spreading over the country including Jiangsu Province. We studied the clinical characteristics and therapies of severe cases in Jiangsu Province.

Methods: A multicenter retrospective cohort study was conducted to analyze clinical, laboratory data and treatment of 60 severe cases with COVID-19 infection in Jiangsu Province between January 24, 2020 and April 20, 2020. The improvement and deterioration subgroups were compared to identify predictors of disease progression.

Results: A total of 653 infected cases with COVID-19 were reported in Jiangsu Province, of which 60 severe cases were included in this study. Up until April 20, 2020, the mortality of severe patients was 0%. The median age was 57 years. The average body mass index of these patients was 25 kg/m². White blood cell counts decreased in 45.0% of patients, lymphopenia in 63.3%, thrombocytopenia in 13.3% and procalcitonin levels in 88.3% of the patients were less than 0.5 ng/mL. There were no statistically significant differences in immunoglobulin therapy and GCs therapy between the improvement and deterioration subgroups. Logistic regression analysis identified higher levels of troponin T (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.00-1.08; P = 0.04), antiviral therapy with aerosol inhalation of interferon (OR: 6.33; 95% CI: 1.18-33.98; P = 0.03), and the application of non-invasive mechanical ventilation (OR: 1.99; 95%CI: 1.17-3.41; P = 0.01) as predictors of disease progression, whereas higher lymphocyte count (OR: 0.11; 95% CI: 0.02-0.57; P = 0.01) and early prone ventilation were associated with improvement (OR: 0.11; 95% CI: 0.01-0.98; P = 0.04).

Conclusions: COVID-19 infection had a low mortality rate in Jiangsu Province, China. The higher levels of troponin T and lower lymphocyte count were predictors of disease progression. Early prone ventilation may be an effective treatment for severe cases.

Keywords: COVID-19; Critical care; Disease progression; Severe patients.

Publication types

Clinical Trial

MeSH terms

Adult
Aged
Aged, 80 and over
Betacoronavirus*
COVID-19
China
Coronavirus Infections* / blood
Coronavirus Infections* / mortality
Coronavirus Infections* / therapy
Female
Humans
Male
Middle Aged
Pandemics*
Pneumonia, Viral* / blood
Pneumonia, Viral* / mortality
Pneumonia, Viral* / therapy
Respiratory Distress Syndrome* / blood
Respiratory Distress Syndrome* / mortality
Respiratory Distress Syndrome* / therapy
Retrospective Studies
SARS-CoV-2