Clinical analysis of nine cases with critical corona virus disease 2019 in Hainan province/ 海南省危重型新型冠状病毒肺炎患者九例临床分析

Objective To explore the clinical features of critical cases of coronavirus disease 2019 (COVID-19) Methods The clinical data of nine patients who were diagnosed with critical COVID-19 in Hainan General Hospital from January 21, 2020 to February 6, 2020 were retrospectively analyzed RT-PCR testing for 2019 novel coronavirus (2019-nCoV) was performed with multi-sites synchronize specimens including pharyngeal swab, blood, excrement, and urine The serum levels of leucocyte, C-reactive protein, procalcitonin and lactic acid between the improved group (five cases) and the deteriorated group (four cases) were compared The t test was used for comparison of normally distributed continuous data between groups Results There were eight males (88 9%) and 1 female enrolled The patients aged 28-77 years old, with an age of (52 9±18 0) years By March 4, 2020, all five cases in improved group were cured and discharged, three cases in deteriorated group died and 1case remained in critical condition All multi-sites specimens of patients in improved group turned negative in 2-4 weeks of illness onset, while those of cases in deteriorated group showed sustained viral nucleic acid positive (up to 48th day of illness onset) The white blood cell counts ((13 52±8 24)×109/L vs (10 49±4 46) ×109/L), C-reactive protein ((139 71±87 46) mg/L vs (78 60±55 40) mg/L) and procalcitonin ((2 32±4 03) ng/mL vs (0 28±0 58) ng/mL) , lactic acid ((3 70±4 14) mmol/L vs (2 33±0 53) mmol/L) in deteriorated group were all significantly higher than those in improved group (t=2 908, 5 009, 4 391 and 2 942, respectively, all P<0 01) A rapid rise of serum IL-6 level up to 8 500 pg/mL was observed in one patient three days prior to death Conclusion Among the patients with critical COVID-19, serum levels of inflammatory cytokines of the death cases are higher than those of improved and discharged cases