Clinical features and risk factors for severe-critically ill COVID-19 adult patients in Jiangsu, China: A multiple-centered, retrospective study

Abstract

Coronavirus disease 2019 (COVID-19) becomes a global pandemic in 2020. Early identification of severe ill patients is a top priority for clinicians. We aimed to describe clinical features and risk factors of severe-critically ill patients with COVID-19 in Jiangsu Province.This multi-centered retrospective study collected the information of 631 laboratory-confirmed COVID-19 patients hospitalized at 28 authorized hospitals in Jiangsu province from January 23, 2019 to March 13, 2020.A total of 583 adult patients with laboratory-confirmed COVID-19 were enrolled for final analysis, including 84 severe-critically ill patients and 499 mild-moderate patients. Median age of the severe-critically ill patients was 57.0 years old (interquartile range, 49.0-65.8), and 50 (59.5%) were males. Multisystemic laboratory abnormalities were observed on admission for severe-critically ill patients. These patients showed more noticeable radiologic abnormalities and more coexisting health issues as compared to the mild-moderate patients. Most of the severe-critically ill COVID-19 patients became deteriorated in 2 weeks after diagnosis. Age, D-dimer, and lymphocytes were independently associated with the progression of severe-critically illness.Older age, higher D-dimer levels and less lymphocyte counts on admission are potential risk factors for COVID-19 patients to develop into severe and critically illness.

Figure 1

Distribution of local laboratory-confirmed coronavirus disease 2019 patients across Jiangsu Province. The numerator represents the number of patients finally included in the study, and the denominator represents the number of local confirmed patients in the 13 municipalities, according to the National Health Commission as March 31, 2020.

Figure 2

Flow chart for patients’ enrollment in the study.

Figure 3

CT findings of severe type confirmed coronavirus disease 2019 pneumonia. A 66-year-old man with close contact history presenting with fever, cough and dyspnea. Chest CT showed diffusely subpleural distributed ground-glass opacities with consolidation of bilateral lungs.

Figure 4

Receiver operating characteristic curves of factors for predicting severe-critically ill patients. Areas under the receiver operating characteristic curve: age was 0.68 (95% confidence interval [CI] 0.62–0.74), D-dimer was 0.79 (95% CI 0.73–0.85), and lymphocytes was 0.74 (95% CI 0.68–0.79). All P < .001. CI = confidence interval, ROC = receiver operating characteristic.