Leukopenia Predicts Risk for Death in Critically Ill Patients with COVID-19 in Wuhan, China: A Single-Centered, Retrospective Study

Background: A pneumonia associated with a novel coronavirus (COVID-19) emerged in Wuhan, Hubei province, China. The epidemiological, clinical characteristics the patients with COVID-19 have been reported, but biomarkers for risk of death have not been well discribed. Methods: Retrospective, single-center case series of the 134 hospitalized patients confirmed with COVID-19 at the Central Hospital of Wuhan, China, from Jan 1 to Feb 20, 2020. All participants were analyzed for real-time RT-PCR, epidemiological, clinical, and radiological, laboratory, microbiological and drug therapy data. Outcomes of moderate vs severe vs critically ill patients, died patients vs non-died ill patients were compared. We aimed to explore potential biomarkers for risk of death in critically ill patients with COVID-19. Findings: 134 discharged patients including deaths hospitalized with COVID-19 pneumonia were included in this study. The median age of all patients was 61.00 years, 69 (51.49 %) of the patients were 60 years or older, and 75 (55.97 %) of the patients were male. 44.03 % patients had cardiovascular disease and 25.37 % patients had endocrine disorder (diabetes). The most common symptom of the patients was fever (84.33 %) and cough (76.87 %). As increase in the severity of COVID-19 pneumonia, higher median values of leukocytes count, neutrophils count, D-dimer and C-reactive protein (all P < 0.05), lower platelets count and albumin (all P < 0.05). After adjusting for age, cardiovascular disease and acute respiratory distress syndrome, plasma levels of albumin remained a significant association with an lower odds ratio for risk of death in critical group (P< 0.05). The area under the curve of albumin was 0.79, the optimal cut-of point for albumin was 35.1 g/ L. At this level, sensitivity was 76.47 %; specificity was 73.81 %. Interpretation: Levels of albumin decreased with the progress of the disease, and could be used as an independent predictive marker for risk of death in critically ill patients with COVID-19, which could help clinicians to idientify patients with high risk of death at an early stage. Funding Statement: This study was supported by the Health and Family Planning Commission of Wuhan City (WX18M02 and WX18C25). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the Ethics Commission of the Central Hospital of Wuhan. Written informed consent was waived by the Ethics Commission of the designated hospital for emerging infectious diseases