Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study
- PMID: 32217556
- PMCID: PMC7190011
- DOI: 10.1136/bmj.m1091
Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study
Erratum in
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Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study.BMJ. 2020 Mar 31;368:m1295. doi: 10.1136/bmj.m1295. BMJ. 2020. PMID: 32234718 No abstract available.
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.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Conflict of interest statement
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.
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Comment in
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Covid-19: risk factors for severe disease and death.BMJ. 2020 Mar 26;368:m1198. doi: 10.1136/bmj.m1198. BMJ. 2020. PMID: 32217618 No abstract available.
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The association between severe or dead COVID-19 and autoimmune diseases: A systematic review and meta-analysis.J Infect. 2020 Sep;81(3):e93-e95. doi: 10.1016/j.jinf.2020.05.065. Epub 2020 Jun 2. J Infect. 2020. PMID: 32502509 Free PMC article. No abstract available.
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