Clinical features of 19 severe cases of COVID-19 in Beijing

Objective To understand the clinical characteristics of patients with Corona Virus Disease 2019 (COVID-19) so as to further provide practical instructions for clinical practice through collecting and analyzing the clinical data of COVID-19 patients admitted to Beijing YuoAnHospital. Methods The clinical data were summarized and analyzed for COVID-19 classified as severe patients and critically ill patients between January 28, 2020 and February 12, 2020 in Beijing You An Hospital,including their age, gender, course of disease, epidemiological history, previous history, clinical symptoms, laboratory tests, CT findings of lungs, treatment and clinical outcomes. Statistical processing was performed using SPSS software (version 22.0). Results 19 patients were included in this study and divided into two groups by investigators, i.e. The percentage of patients was 10 for the severe type and 9 for the critically ill type. The average age of the patients was 75 years (range from 58 to 94 years), including 10 males and 9 females. Their course of diseases varied from 1 days to 14 days with a median of 5 days. Among these patients, 4 patients did used to reside in Wuhan, 13 patients had been in close contact with confirmed patients (including family gatherings, meals, living in the same room, etc.), and 2 patients had no relevant epidemiological history. 14 patients suffered from underlying chronic diseases (including 11 cases of hypertension, 4 cases of coronary heart disease, 4 cases of cardiac insufficiency, 3 cases of chronic obstructive pulmonary disease, 2 cases of previous anterior myocardial infarction, 3 cases of arrhythmia, 1 case of heart valve disorders, 2 cases of diabetes mellitus, 2 cases of chronic renal disease, etc.), and 4 patients were accompanied with 3 or more underlying diseases at the same time. The first symptoms at onset of illness were fever in 18 cases, cough in 13 cases, and dyspnea in 8 cases. 17 patients were accompanied with absolute lymphocyte count (ALC) lower than the normal range. 11 patients experience different degrees of hepatic injury, 10 patients had renal injury, 7 patients had abnormal myocardial enzymes in a varying degree. C-reactive protein was increased in 18 patients.12 patients received hormone therapy, 4 patients were treated with gamma globulin, 3 patients used non-invasive ventilator mechanical ventilation, and 7 patients used an invasive ventilator to assist ventilation. Moreover, 1 patients received continuous renal replacement therapy (CRRT), and 1 patient was treated with extracorporeal membrane oxygenation (ECMO). As of February 17, 2020, 10 patients had recovered or been discharged upon treatment, 4 patients were still in the intensive care unit (ICU), and 5 patients had died. Conclusions The elderly and individuals accompanied with underlying diseases were considered as independent predictors for developing severe and critically ill population, and were faced with increased mortality. The decrease of ALC and the increase of C-reactive protein levels in the patients, and the abnormality of liver function, renal function and myocardial enzyme spectrum in different degrees suggests the correlation with severe cases. Hormone and ventilator are effective in the treatment of severe cases. Key words: 2019-nCoV; clinical features; COVID-19; Critically ill diseases