Epidemiological and clinical characteristics of 20 severe cases of coronavirus disease 2019 in Sichuan Province_West China Medical Journal

Authors：

ZENG Mingquan ¹ , LEI Xuezhong ² , ZHANG Minli ³ ,  CHEN Zhu ^1,2 , CHEN Hong ¹ , ZHANG Ling ¹ , WANG Bo ⁴ , JIANG Hongmei ¹ , RAN Qihui ¹ , DENG Chao ¹ , ZHANG Lihui ¹ , DU Qing ¹

1. Intensive Care Unit, Public Health Clinical Center of Chengdu, Chengdu, Sichuan 610066, P. R. China;
2. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Anesthesiology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, P. R. China;
4. Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHEN Zhu, Email: chen-zoey@163.com

Keywords：

Coronavirus disease 2019; Severe pneumonia; Epidemiology; Clinical feature

DOI：

10.7507/1002-0179.202003182

Video：

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Objective To analyze the epidemiological and clinical characteristics of severe cases of coronavirus disease 2019 (COVID-19) in order to provide reference for clinical diagnosis and treatment.Method The epidemiological histories, clinical characteristics, laboratory examinations, chest images, and treatment outcomes of 20 confirmed cases of severe COVID-19 admitted to Public Health Clinical Center of Chengdu from January 16th to February 5th, 2020 were retrospectively analyzed.Results Among the 20 patients with severe COVID-19, 12 were male and 8 were female. The age ranged from 34 to 84 years old, with an average of (57.4±16.5) years old. Thirteen patients (65.0%) had one or more co-existing diseases, such as hypertension (9 cases), diabetes (6 cases), and coronary atherosclerotic heart disease (4 cases). Eleven cases (55.0%) had a history of living or traveling in Wuhan, 4 cases (20.0%) had a history of living in non-Wuhan areas of Hubei Province, 3 cases (15.0%) had a history of contact with confirmed COVID-19 patients, while 2 cases had no above-mentioned epidemiological history, but had a history of traveling in non-epidemic areas. The main symptoms were fever (100.0%), cough (100.0%), shortness of breath (75.0%), and fatigue (65.0). Some patients developed into acute respiratory distress syndrome in 3-10 d after onset. The white blood cell count of the patients was normal or decreased, the hypersensitive C-reactive protein and serum amyloid protein significantly increased, while the CD4⁺ T lymphocyte count and CD56⁺ natural killer cell count significantly decreased. Sixteen patients (80.0%) were given transnasal hyperbaric oxygenation [among whom 6 patients (30.0%) were transferred to non-invasive ventilator after no improvement], 3 patients (15.0%) were given tracheal intubated ventilator, and 1 patient (5.0%) was treated by tracheal intubated ventilator combined with extracorporeal membrane oxygenation to support breathing. By April 8th, 2020, 3 patients died and the remaining 17 had been cured and discharged, with an average length of hospital stay of 21.4 d. The 3 death cases were all elderly with underlying diseases such as heart disease and pulmonary disease.Conclusions Severe COVID-19 is associated with hypertension, diabetes, heart disease, and other basic diseases, and some patients develope acute respiratory distress syndrome. Respiratory support may help to improve prognosis.

Citation： ZENG Mingquan, LEI Xuezhong, ZHANG Minli, CHEN Zhu, CHEN Hong, ZHANG Ling, WANG Bo, JIANG Hongmei, RAN Qihui, DENG Chao, ZHANG Lihui, DU Qing. Epidemiological and clinical characteristics of 20 severe cases of coronavirus disease 2019 in Sichuan Province. West China Medical Journal, 2020, 35(4): 377-384. doi: 10.7507/1002-0179.202003182 Copy

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11.	Leem AY, Park B, Kim YS, et al. Incidence and risk of chronic obstructive pulmonary disease in a Korean community-based cohort. Int J Chron Obstruct Pulmon Dis, 2018, 5(13): 509-517.
12.	Guo L, Wei D, Zhang X, et al. Clinical features predicting mortality risk in patients with viral pneumonia: the MuLBSTA score. Front Microbiol, 2019, 3(10): 2752.
13.	La Gruta NL, Kedzierska K, Stambas J, et al. A question of self-preservation: immunopathology in influenza virus infection. Immunol Cell Biol, 2007, 85(2): 85-92.
14.	Chung M, Bernheim A, Mei X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology, 2020, 295(1): 202-207.
15.	Koo HJ, Lim S, Choe J, et al. Radiographic and CT features of viral pneumonia. Radiographics, 2018, 38(3): 719-739.
16.	Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 2020, 323(11): 1061-1069.
17.	华中科技大学同济医学院附属同济医院救治医疗专家组. 新型冠状病毒感染的肺炎诊疗快速指南 (第三版). (2020-01-28)[2020-03-04]. https://www.tjh.com.cn/html/2020/0128/28713.shtml.
18.	白浪, 王铭, 唐小琼, 等. 对新型冠状病毒肺炎诊疗中的热点问题的思考. 华西医学, 2020, 35(2): 125-131.

1. Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-Infected pneumonia. N Engl J Med, 2020, 382(13): 1199-1207.
2. 中华人民共和国国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案 (试行第七版). (2020-03-03)[2020-03-04]. http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml.
3. 熊成龙, 蒋露芳, 姜庆五. β-冠状病毒引起人类疾病的流行与控制. 上海预防医学, 2020, 32(1): 57-65.
4. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
5. WHO. Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: interim guidance. (2020-01-11)[2020-03-04]. https://www.who.int/internalpublications-detail/clinical-management-of-severe-acute-respiratoryinfection-when-novel-coronavirus-(ncov)-infection-is-suspected.
6. Shimabukuro-Vornhagen A, Gödel P, Subklewe M, et al. Cytokine release syndrome. J Immunother Cancer, 2018, 6(1): 56.
7. Chousterman BG, Swirski FK, Weber GF. Cytokine storm and sepsis disease pathogenesis. Semin Immunopathol, 2017, 39(5): 517-528.
8. Younan P, Iampietro M, Nishida AA, et al. Ebola virus binding to Tim-1 on T lymphocytes induces a cytokine storm. MBio, 2017, 8(5): e00845-17.
9. Ko JH, Park GE, Lee JY, et al. Predictive factors for pneumonia development and progression to respiratory failure in MERS-CoV infected patients. J Infect, 2016, 73(5): 468-475.
10. Liu CL, Lu YT, Peng MJ, et al. Clinical and laboratory features of severe acute respiratory syndrome vis-a-vis onset of fever. Chest, 2004, 126(2): 509-517.
11. Leem AY, Park B, Kim YS, et al. Incidence and risk of chronic obstructive pulmonary disease in a Korean community-based cohort. Int J Chron Obstruct Pulmon Dis, 2018, 5(13): 509-517.
12. Guo L, Wei D, Zhang X, et al. Clinical features predicting mortality risk in patients with viral pneumonia: the MuLBSTA score. Front Microbiol, 2019, 3(10): 2752.
13. La Gruta NL, Kedzierska K, Stambas J, et al. A question of self-preservation: immunopathology in influenza virus infection. Immunol Cell Biol, 2007, 85(2): 85-92.
14. Chung M, Bernheim A, Mei X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology, 2020, 295(1): 202-207.
15. Koo HJ, Lim S, Choe J, et al. Radiographic and CT features of viral pneumonia. Radiographics, 2018, 38(3): 719-739.
16. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 2020, 323(11): 1061-1069.
17. 华中科技大学同济医学院附属同济医院救治医疗专家组. 新型冠状病毒感染的肺炎诊疗快速指南 (第三版). (2020-01-28)[2020-03-04]. https://www.tjh.com.cn/html/2020/0128/28713.shtml.
18. 白浪, 王铭, 唐小琼, 等. 对新型冠状病毒肺炎诊疗中的热点问题的思考. 华西医学, 2020, 35(2): 125-131.

West China Medical Journal

Epidemiological and clinical characteristics of 20 severe cases of coronavirus disease 2019 in Sichuan Province

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