Clinical Characteristics of 77 Novel Coronavirus 2019 Infected Patients with Respiratory Failure in the Terminal Stage in Wuhan

Background: Recently, the coronavirus disease 2019 (COVID-19) has widely spread over China, and might cause respiratory failure with high mortality. This study reports the clinical characteristics of COVID-19 with respiratory failure in the terminal stage. Methods: It was retrospectively analyzed for the clinical information of 77 COVID-19 patients with respiratory failure in the terminal stage at Tongji Hospital, Wuhan, China, from January 28 to February 26, 2020. Findings: For the 77 patients with confirmed COVID-19, their median age was 70.0 years old (IQR 62.0-78.0), and an approximately 2.2:1.0 male-to-female ratio was found. The common comorbidity was diabetes (41 [53.2%]), hypertension (38 [49.4%]). Lymphocytopenia (0.5×109/L [IQR 0.4-0.7]) at admission was observed in all patients and continued to reduce in the terminal stage. Notably, the number of platelets generally remained normal when admission but showed rapid decrease (49.0×109/L [IQR 28.0-81.0]) at the terminal stage. Other laboratory results revealed elevated levels of lactate dehydrogenase (LDH), C-reactive protein, ferritin, and cytokines IL-2R, IL-6, IL-10 and TNFα. Patients accompanied by diabetes had lower levels of albumin (29.1 g/L vs. 31.1 g/L), and higher levels of LDH (597.0 U/L vs. 475.0 U/L) and Hypersensitive cardiac troponin (88.6 U/L vs. 22.0 U/L). All patients received antibiotic and antiviral therapy while 75 (97.4%) patients received glucocorticoids. Furthermore, 62 patients (80.5%) received invasive mechanical ventilation (IMV). Unfortunately, no significant difference was observed between IMV group and non-IMV group (P=0.802). Interpretation: COVID-19 patients accompanied by diabetes, and with laboratory characteristics of lymphocytopenia and thrombocytopenia, elevated concentration of plasma cytokines IL-2R, IL6, IL-10 and TNFα, other factors (CRP, LDH and ferritin) were associated with disease severity. For these patients, however, IMV could not significantly improved the prognosis. It’s important for timely treatments to reverse the progression to respiratory failure. Funding Statement: This work was funded by the National Science Foundation of China (No.81500082). Declaration of Interest: All authors declare no competing interests. Ethics Approval Statement: Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Institutional Review Board Approval TJ-IRB20200316