AUTHOR=Zou Li , Dai Lijun , Zhang Yangyang , Fu Wenning , Gao Yan , Zhang Zhaohui , Zhang Zhentao 

TITLE=Clinical Characteristics and Risk Factors for Disease Severity and Death in Patients With Coronavirus Disease 2019 in Wuhan, China

JOURNAL=Frontiers in Medicine

VOLUME=Volume 7 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.00532

DOI=10.3389/fmed.2020.00532

ISSN=2296-858X

ABSTRACT=Objective: To describe the clinical manifestations and outcomes of COVID-19, and explore the risk factors of deterioration and death of the disease.
Methods: In this retrospective study, we collected data from 121 COVID-19 cases confirmed by RT-PCR and next-generation sequencing in Renmin Hospital of Wuhan University from January 30, 2019, to March 23, 2020, and conducted statistical analysis.
Results: A total of 121 patients were included in our study, the median age was 65 years (IQR, 55.0 to 71.5 years), and 54.5% cases were men. Among those cases, 52 (43.0%) cases progressed to severe, and 14 (11.6%) died. Overall, the most common manifestations were fever (78.5%) and respiratory symptoms (77.7%), while neurological symptoms were found in only 9.9% of the patients. 70.2% of all the cases had comorbidities, including hypertension (40.5%) and diabetes (20.7%). On admission, cases usually show elevated levels of neutrophils (27.3%), D-dimer (72.6%), Interleukin-6 (35.2%), Interleukin-10 (64.4%), high-sensitivity C-reactive protein (82.6%), and lactate dehydrogenase (62.0%), and decreased levels of lymphocytes (66.9%), CD3 cells (67.2%) and CD4 cells (63.0%). The proportional hazard Cox models showed that the risk factors for severity progression and death included comorbidities (HR:4.53, 95%CI:1.78-11.55 and HR:7.81, 95%CI:1.02-59.86), leukocytosis (HR:1.13; 95%CI:1.05-1.22 and HR:1.25, 95%CI:1.10-1.42), neutrophilia (HR:1.15, 95%CI:1.07-1.13 and HR:1.28, 95%CI:1.13-1.46, and elevated LDH (HR:1.14, 95%CI:1.12-1.15 and HR:1.11, 95%CI:1.10-1.12). Elevated D-dimer (HR:1.02, 95%CI:1.01-1.03), IL-6 (HR: 1.01, 95%CI:1.00-1.02) and IL-10 levels (HR:1.04, 95%CI:1.01-1.07) were also risk factors for the progression of disease severity. Meanwhile, lymphopenia and wake immune responses (e.g. lower CD3, CD4, or CD19 counts [all HR<1]) were associated with disease deterioration and death.
Conclusions: Severe cases and death of COVID-19 are associated with older age, comorbidities, organ dysfunction, lymphopenia, high cytokines, and weak immune responses.