COVID-19: high mortality among critically ill pneumonia patients in Wuhan

  • Lancet Resp Med

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Among patients in Wuhan, China, who are critically ill with novel coronavirus (COVID-19)-associated pneumonia, mortality exceeds 50%.
  • Older men are especially vulnerable, at least in this region.
  • Serial radiographic examinations may be useful.
  • Fever is sometimes delayed. 

Why this matters

  • As COVID-19 spreads, information on clinical manifestations is urgently needed. 

Key results

  • Mean age: 59.7 years; 67% men.
  • 98% had fever, but it was not detected in 11.5% until 2-8 days after illness onset.
  • Median duration from symptom onset to:
    • Radiological confirmation of pneumonia: 5 days.
    • ICU admission: 9.5 days.
  • 71% required mechanical ventilation.
  • 85% showed lymphocytopenia.
  • Organ damage incidence:
    • Acute respiratory distress syndrome (ARDS): 67%.
    • Acute kidney injury: 29%.
    • Cardiac injury: 23%; median high-sensitivity troponin I: 161.0 (interquartile range, 41.8-766.1) pg/mL. 
    • Liver dysfunction: 29%.
  • Hospital-acquired infection: 13.5%.
  • 28-day mortality: 61.5%.
    • Median survival duration after ICU admission: 7 days.
  • Compared with survivors, nonsurvivor group was older and had higher rates of chronic illness, ARDS, and mechanical ventilation requirement.

Study design

  • Single-center retrospective observational study (n=52).
  • Researchers assessed adults with COVID-19 pneumonia in dedicated Wuhan ICU from December 24, 2019 to January 26, 2020.
  • Outcome: 28-day mortality following ICU admission.
  • Funding: None.

Limitations

  • Must be considered exploratory.