Clinical characteristics of 101 COVID-19 nonsurvivors in Wuhan, China: a retrospective study

Shi, Qiao; Zhao, Kailiang; Yu, Jia; Jiang, Fang; Feng, Jiarui; Zhao, Kaiping; Zhang, Xiaoyi; Chen, Xiaoyan; Hu, Peng; Hong, Yupu; Li, Man; Liu, Fang; Chen, Chen; Wang, Weixing

Background The outbreak of COVID-19 has aroused global concerns. Few studies focused on characteristics of COVID-19 nonsurvivors. Objective In this study, we aimed to describe the clinical characteristics of 101 nonsurvivors with COVID-19 and analyze risk factors associated with the rapid disease progress to death after admission. Design Retrospective study using electronic medical records. Participants 101 hospitalized patients with confirmed COVID-19 died in Renmin Hospital of Wuhan University before February 15, 2020, were included in this study. Main measures We obtained epidemiological, demographic, clinical, laboratory, and outcome data from electronic medical records. Univariate logistic regression analyses were performed to evaluate risk factors associated with rapid disease progress to death after admission. Key results Among included nonsurvivors, the median age was 71.0 years (IQR, 59.0-80.0), 60 (59.4%) were men. Eighty-two (79.2%) had one or more comorbidities including hypertension (58.4%), diabetes (21.8%) etc. Respiratory failure (99.0%), acute cardiac injury (52.5%), sepsis (40.6%) and acute kidney injury (22.8%) were most common complications. Patients died within 3 days of admission were more likely to develop sepsis compared with those survived 3 days of admission. Higher heart rate and respiration rate, increased white blood cell count and neutrophil count, elevated myoglobin level and depressed oxygen saturation on admission were associated with rapid disease progress to death within 3 days of admission. The AUCs for white blood cell count and neutrophil count were 0.71 (95% CI, 0.60-0.80) and 0.70 (95% CI, 0.59-0.79), respectively. Conclusions Older patients with underlying comorbidities suffering COVID-19 were at increased risks of death. Respiratory failure, acute cardiac injury and acute kidney injury played crucial roles in the death of COVID-19 patients. Of importance, early development of sepsis, increased white blood cell count and neutrophil count on admission were associated with the rapid disease progress to death.