COVID-19 with Different Severities: A Multicenter Study of Clinical Features

Am J Respir Crit Care Med. 2020 Jun 1;201(11):1380-1388. doi: 10.1164/rccm.202002-0445OC.


Rationale: The coronavirus disease (COVID-19) pandemic is now a global health concern.Objectives: We compared the clinical characteristics, laboratory examinations, computed tomography images, and treatments of patients with COVID-19 from three different cities in China.Methods: A total of 476 patients were recruited from January 1, 2020, to February 15, 2020, at three hospitals in Wuhan, Shanghai, and Anhui. The patients were divided into four groups according to age and into three groups (moderate, severe, and critical) according to the fifth edition of the Guidelines on the Diagnosis and Treatment of COVID-19 issued by the National Health Commission of China.Measurements and Main Results: The incidence of comorbidities was higher in the severe (46.3%) and critical (67.1%) groups than in the moderate group (37.8%). More patients were taking angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in the moderate group than in the severe and critical groups. More patients had multiple lung lobe involvement and pleural effusion in the critical group than in the moderate group. More patients received antiviral agents within the first 4 days in the moderate group than in the severe group, and more patients received antibiotics and corticosteroids in the critical and severe groups. Patients >75 years old had a significantly lower survival rate than younger patients.Conclusions: Multiple organ dysfunction and impaired immune function were the typical characteristics of patients with severe or critical illness. There was a significant difference in the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers among patients with different severities of disease. Involvement of multiple lung lobes and pleural effusion were associated with the severity of COVID-19. Advanced age (≥75 yr) was a risk factor for mortality.

Keywords: ACEI/ARB; COVID-19; multiple lung lobe involvement; pleural effusion; severity.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Betacoronavirus
  • COVID-19
  • China / epidemiology
  • Comorbidity
  • Coronavirus Infections / mortality
  • Coronavirus Infections / physiopathology*
  • Critical Illness
  • Female
  • Hospital Mortality
  • Humans
  • Incidence
  • Lung / pathology
  • Male
  • Middle Aged
  • Multiple Organ Failure / virology
  • Pandemics
  • Pleural Effusion / virology
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / physiopathology*
  • SARS-CoV-2
  • Tomography, X-Ray Computed


  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors