Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan. A Retrospective Observational Study

Abstract

Rationale: The global death toll from coronavirus disease (COVID-19) virus as of May 12, 2020, exceeds 286,000. The risk factors for death were attributed to advanced age and comorbidities but have not been accurately defined.Objectives: To report the clinical features of 85 fatal cases of COVID-19 in two hospitals in Wuhan.Methods: Medical records were collected of 85 fatal cases of COVID-19 between January 9, 2020, and February 15, 2020. Information recorded included medical history, exposure history, comorbidities, symptoms, signs, laboratory findings, computed tomographic scans, and clinical management.Measurements and Main Results: The median age of the patients was 65.8 years, and 72.9% were male. Common symptoms were fever (78 [91.8%]), shortness of breath (50 [58.8%]), fatigue (50 [58.8%]), and dyspnea (60 [70.6%]). Hypertension, diabetes, and coronary heart disease were the most common comorbidities. Notably, 81.2% of patients had very low eosinophil counts on admission. Complications included respiratory failure (80 [94.1%]), shock (69 [81.2%]), acute respiratory distress syndrome (63 [74.1%]), and arrhythmia (51 [60%]), among others. Most patients received antibiotic (77 [90.6%]), antiviral (78 [91.8%]), and glucocorticoid (65 [76.5%]) treatments. A total of 38 (44.7%) and 33 (38.8%) patients received intravenous immunoglobulin and IFN-α2b, respectively.Conclusions: In this depictive study of 85 fatal cases of COVID-19, most cases were males aged over 50 years with noncommunicable chronic diseases. The majority of the patients died of multiple organ failure. Early onset of shortness of breath may be used as an observational symptom for COVID-19 exacerbations. Eosinophilopenia may indicate a poor prognosis. A combination of antimicrobial drugs did not offer considerable benefit to the outcome of this group of patients.

Keywords: copathogen; coronavirus disease 2019; eosinophilopenia; fatal cases; severe acute respiratory syndrome coronavirus 2.

Figure 1.

(A) Chest computed tomographic (CT) images of a 55-year-old male patient with coronavirus disease (COVID-19) taken on January 27, 2020, showing unilateral pneumonia. (B) Chest CT images of an 85-year-old male patient with COVID-19 taken on February 4, 2020, showing ground-glass opacity in both lungs. (C) Chest CT images of a 23-year-old female patient with COVID-19 taken on January 24, 2020, showing diffusive ground-glass opacity. (D) Chest CT images of a 72-year-old male patient with COVID-19 taken on January 30, 2020, showing bilateral pneumonia.

Figure 2.

A Kaplan-Meier survival curve from the time of admission with coronavirus disease (COVID-19) to time of death.