Clinical outcomes of COVID-19 in Wuhan, China: a large cohort study

Abstract

Background: Since December 2019, an outbreak of Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) initially emerged in Wuhan, China, and has spread worldwide now. Clinical features of patients with COVID-19 have been described. However, risk factors leading to in-hospital deterioration and poor prognosis in COVID-19 patients with severe disease have not been well identified.

Methods: In this retrospective, single-center cohort study, 1190 adult inpatients (≥ 18 years old) with laboratory-confirmed COVID-19 and determined outcomes (discharged or died) were included from Wuhan Infectious Disease Hospital from December 29, 2019 to February 28, 2020. The final follow-up date was March 2, 2020. Clinical data including characteristics, laboratory and imaging information as well as treatments were extracted from electronic medical records and compared. A multivariable logistic regression model was used to explore the potential predictors associated with in-hospital deterioration and death.

Results: 1190 patients with confirmed COVID-19 were included. Their median age was 57 years (interquartile range 47-67 years). Two hundred and sixty-one patients (22%) developed a severe illness after admission. Multivariable logistic regression demonstrated that higher SOFA score (OR 1.32, 95% CI 1.22-1.43, per score increase, p < 0.001 for deterioration and OR 1.30, 95% CI 1.11-1.53, per score increase, p = 0.001 for death), lymphocytopenia (OR 1.81, 95% CI 1.13-2.89 p = 0.013 for deterioration; OR 4.44, 95% CI 1.26-15.87, p = 0.021 for death) on admission were independent risk factors for in-hospital deterioration from not severe to severe disease and for death in severe patients. On admission D-dimer greater than 1 μg/L (OR 3.28, 95% CI 1.19-9.04, p = 0.021), leukocytopenia (OR 5.10, 95% CI 1.25-20.78), thrombocytopenia (OR 8.37, 95% CI 2.04-34.44) and history of diabetes (OR 11.16, 95% CI 1.87-66.57, p = 0.008) were also associated with higher risks of in-hospital death in severe COVID-19 patients. Shorter time interval from illness onset to non-invasive mechanical ventilation in the survivors with severe disease was observed compared with non-survivors (10.5 days, IQR 9.25-11.0 vs. 16.0 days, IQR 11.0-19.0 days, p = 0.030). Treatment with glucocorticoids increased the risk of progression from not severe to severe disease (OR 3.79, 95% CI 2.39-6.01, p < 0.001). Administration of antiviral drugs especially oseltamivir or ganciclovir is associated with a decreased risk of death in severe patients (OR 0.17, 95% CI 0.05-0.64, p < 0.001).

Conclusions: High SOFA score and lymphocytopenia on admission could predict that not severe patients would develop severe disease in-hospital. On admission elevated D-dimer, leukocytopenia, thrombocytopenia and diabetes were independent risk factors of in-hospital death in severe patients with COVID-19. Administration of oseltamivir or ganciclovir might be beneficial for reducing mortality in severe patients.

Keywords: COVID-19; Development; Mortality; Risk factors; Severe.

Fig. 1

Flowchart in the present study

Fig. 2

Odds ratios for risk factors associated with in-hospital progression a in COVID-19 patients and in-hospital mortality b in severe COVID-19 patients. SOFA: Sequential Organ Failure Assessment. IMV: invasive mechanical ventilation. Nasal cannula, glucocorticoids treatment, IMV and antiviral drugs during hospital stay; SOFA score, pulmonary consolidation, leukocytosis, thrombocytopenia and lymphocytopenia, prothrombin time and D-dimer on admission

Fig. 3

Survival curve in with coronavirus disease. a In all enrolled patients. b In not severe and severe patients. Nine patients died on admission as a result of unsuccessful rescue efforts

Fig. 4

Cumulative survival curves among severe COVID-19 patients. a With DM and without DM; b SOFA score > 5 and SOFA score ≤ 5 on admission; c PLT counts on admission; d Lym counts on admission; e D-dimmer on admission. DM diabetes mellitus, SOFA Sequential Organ Failure Assessment, PLT platelet; Lym lymphocyte

Fig. 5

Cumulative survival curve in severe COVID-19 patients with oseltamivir or ganciclovir. a Use of ganciclovir during hospital stay reduced the risk of death (hazard ratio, 0.20; 95% CI 0.07–0.55; p < 0.001). b Use of oseltamivir during hospital stay reduced the risk of death (hazard ratio, 0.21; 95% CI 0.10–0.43; p < 0.001)

Fig. 6

Time interval between admission and disease onset to respiratory supports. Respiratory supports include high-flow oxygen, non-invasive mechanical ventilation, invasive mechanical ventilation and ECMO. ECMO extracorporeal membrane oxygenation