Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study

doi:10.1007/s00134-020-06211-2

Multicenter Study

. 2020 Oct;46(10):1863-1872.

doi: 10.1007/s00134-020-06211-2. Epub 2020 Aug 20.

Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study

Jianfeng Xie^#¹, Wenjuan Wu^#², Shusheng Li^#³, Yu Hu^#⁴, Ming Hu^#⁵, Jinxiu Li^#⁶, Yi Yang¹, Tingrong Huang⁷, Kun Zheng⁸, Yishan Wang⁹, Hanyujie Kang⁹, Yingzi Huang¹, Li Jiang¹⁰, Wei Zhang¹¹, Ming Zhong¹², Ling Sang¹³, Xia Zheng¹⁴, Chun Pan¹, Ruiqiang Zheng¹⁵, Xuyan Li⁹, Zhaohui Tong¹⁶, Haibo Qiu¹⁷, Bin Du¹⁸

Affiliations

¹ Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.
² Department of Critical Care Medicine, Wuhan Jin-Yintan Hospital, Wuhan, 430071, China.
³ Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430030, China.
⁴ Department of Critical Care Medicine, Union Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430022, China.
⁵ Department of Infection Disease, Wuhan Pulmonary Hospital, Wuhan, China.
⁶ Department of Critical Care Medicine, Shenzhen Third Hospital, Shenzhen, China.
⁷ Department of Critical Care Medicine, Huangshi Hospital of Chinese Medicine, Huangshi, 435000, China.
⁸ Department of Critical Care Medicine, Huangshi Central Hospital, Huangshi, 435000, China.
⁹ Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.
¹⁰ Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
¹¹ Emergency Department, The 900th Hospital of Joint Service Corps of Chinese PLA, Fuzhou, 350025, China.
¹² Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
¹³ Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
¹⁴ Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
¹⁵ Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, 225001, China.
¹⁶ Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China. tongzhaohuicy@sina.com.
¹⁷ Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China. haiboq2000@163.com.
¹⁸ Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and, Chinese Academy of Medical Sciences, Beijing, 100730, China. dubin98@gmail.com.

^# Contributed equally.

PMID: 32816098
PMCID: PMC7439240
DOI: 10.1007/s00134-020-06211-2

Multicenter Study

Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study

Jianfeng Xie et al. Intensive Care Med. 2020 Oct.

. 2020 Oct;46(10):1863-1872.

doi: 10.1007/s00134-020-06211-2. Epub 2020 Aug 20.

Authors

Affiliations

¹ Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.
² Department of Critical Care Medicine, Wuhan Jin-Yintan Hospital, Wuhan, 430071, China.
³ Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430030, China.
⁴ Department of Critical Care Medicine, Union Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430022, China.
⁵ Department of Infection Disease, Wuhan Pulmonary Hospital, Wuhan, China.
⁶ Department of Critical Care Medicine, Shenzhen Third Hospital, Shenzhen, China.
⁷ Department of Critical Care Medicine, Huangshi Hospital of Chinese Medicine, Huangshi, 435000, China.
⁸ Department of Critical Care Medicine, Huangshi Central Hospital, Huangshi, 435000, China.
⁹ Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.
¹⁰ Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
¹¹ Emergency Department, The 900th Hospital of Joint Service Corps of Chinese PLA, Fuzhou, 350025, China.
¹² Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
¹³ Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
¹⁴ Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
¹⁵ Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, 225001, China.
¹⁶ Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China. tongzhaohuicy@sina.com.
¹⁷ Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China. haiboq2000@163.com.
¹⁸ Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and, Chinese Academy of Medical Sciences, Beijing, 100730, China. dubin98@gmail.com.

^# Contributed equally.

PMID: 32816098
PMCID: PMC7439240
DOI: 10.1007/s00134-020-06211-2

Abstract

Purpose: An ongoing outbreak of coronavirus disease 2019 (COVID-19) emerged in Wuhan since December 2019 and spread globally. However, information about critically ill patients with COVID-19 is still limited. We aimed to describe the clinical characteristics and outcomes of critically ill patients with COVID-19 and figure out the risk factors of mortality.

Methods: We extracted data retrospectively regarding 733 critically ill adult patients with laboratory-confirmed COVID-19 from 19 hospitals in China through January 1 to February 29, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were collected. The primary outcome was 28-day mortality. Data were compared between survivors and non-survivors.

Results: Of the 733 patients included in the study, the median (IQR) age was 65 (56-73) years and 256 (34.9%) were female. Among these patients, the median (IQR) APACHE II score was 10 (7 to 14) and 28-day mortality was 53.8%. Respiratory failure was the most common organ failure (597 [81.5%]), followed by shock (20%), thrombocytopenia (18.8%), central nervous system (8.6%) and renal dysfunction (8%). Multivariate Cox regression analysis showed that older age, malignancies, high APACHE II score, high D-dimer level, low PaO₂/FiO₂ level, high creatinine level, high hscTnI level and low albumin level were independent risk factors of 28-day mortality in critically ill patients with COVID-19.

Conclusion: In this case series of critically ill patients with COVID-19 who were admitted into the ICU, more than half patients died at day 28. The higher percentage of organ failure in these patients indicated a significant demand for critical care resources.

Keywords: COVID-19; Critically ill; Mortality; Organ failure.

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Conflict of interest statement

We declare no competing interests.

Figures

**Fig. 1**
Survival of critically ill patients with COVID-19 admitted to ICU. Dashed lines represent 95% CI

**Fig. 2**
Temporal changes in laboratory markers from ICU admission in critically ill patients with COVID-19. Figure shows temporal changes in P/F ratio (a), lymphocytes (b), hs-CRP (c), d-dimer (d), LDH (e), and hsc-TnI (f). Differences between survivors and non-survivors were significant for all time points shown. *hs-CRP* high-sensitive C-reactive protein, *LDH* lactate dehydrogenase, *hsc-TnI* high-sensitivity cardiac troponin I

See this image and copyright information in PMC

Comment in

Critically ill patients with COVID-19: are they hemodynamically unstable and do we know why?
Michard F, Vieillard-Baron A. Michard F, et al. Intensive Care Med. 2021 Feb;47(2):254-255. doi: 10.1007/s00134-020-06238-5. Epub 2020 Sep 10. Intensive Care Med. 2021. PMID: 32910203 Free PMC article. No abstract available.

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[1] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed

[2] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed

[3] WHO. WHO Coronavirus Disease (COVID-19) Dashboard. Available at https://covid19.who.int. Accessed 19 July 2020

[4] WHO. WHO Coronavirus Disease (COVID-19) Dashboard. Available at https://covid19.who.int. Accessed 19 July 2020

[5] Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA. 2020;323:1612–1614. doi: 10.1001/jama.2020.4326. - DOI - PMC - PubMed

[6] Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA. 2020;323:1612–1614. doi: 10.1001/jama.2020.4326. - DOI - PMC - PubMed

[7] Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475–481. doi: 10.1016/S2213-2600(20)30079-5. - DOI - PMC - PubMed

[8] Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475–481. doi: 10.1016/S2213-2600(20)30079-5. - DOI - PMC - PubMed

[9] Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, Greninger AL, Pipavath S, Wurfel MM, Evans L, Kritek PA, West TE, Luks A, Gerbino A, Dale CR, Goldman JD, O'Mahony S, Mikacenic C. Covid-19 in critically ill patients in the Seattle region—case series. N Engl J Med. 2020;382:2012–2022. doi: 10.1056/NEJMoa2004500. - DOI - PMC - PubMed

[10] Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, Greninger AL, Pipavath S, Wurfel MM, Evans L, Kritek PA, West TE, Luks A, Gerbino A, Dale CR, Goldman JD, O'Mahony S, Mikacenic C. Covid-19 in critically ill patients in the Seattle region—case series. N Engl J Med. 2020;382:2012–2022. doi: 10.1056/NEJMoa2004500. - DOI - PMC - PubMed

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Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study

Affiliations

Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study

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Abstract

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Abstract

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