Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study

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.

Fig 1

Representative chest computed tomographic images of patients with covid-19 who died and patients who recovered. A-D are chest computed tomograms showing axial view lung window from two deceased patients. Case 1 was a 57 year old women, and case 2 was a 53 year old man. E-H are chest computed tomograms images from a 33 year old woman who recovered. A: image obtained on day 10 after symptom onset shows multiple ground glass opacities and consolidation in bilateral lungs. B: image obtained on day 18 after symptom onset shows progressive multiple ground glass opacities and consolidation in bilateral lungs. C: image obtained on day 9 after symptom onset shows multiple ground glass opacities in bilateral lungs and solid nodule in right lower lobe. D: image obtained on day 13 after symptom onset shows progressive ground glass opacities in bilateral lungs and decreased density of solid nodule in right lower lobe. E: image obtained on day 4 after symptom onset shows right middle lobe and lower lobe consolidation and ground glass opacities. F: image obtained on day 7 after symptom onset shows progressive right middle lobe and lower lobe consolidation and ground glass opacities. G: image obtained on day 11 after symptom onset shows progressive multiple ground glass opacities and consolidation in bilateral lungs and decreased density and range of right middle lobe consolidation. H: after 17 days’ therapy, follow-up computed tomograms show ground glass opacities, and consolidation are obviously resolved in bilateral lungs