The characteristics and outcomes of 681 severe cases with COVID-19 in China

Abstract

Purpose: To clarify the epidemiological, clinical, and therapeutic features of patients with severe COVID-19.

Methods: In this study, we enrolled 681 patients with confirmed cases of severe COVID-19. The epidemiological, demographic, clinical, laboratory, treatment, and outcome data were collected.

Results: The median age of the study participants was 65 years, 53.2% were male, and 104 (15.3%) died. Age, Neutrophil-To-Lymphocyte Ratio (NLR), acute myocardial injury, and levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), and CD3 T cells counts were independently associated with death, while arbidol and ribavirin were protective from death. The combination of NLR and acute myocardial injury on admission (AUC = 0.914) predicted mortality better than NLR, CRP, LDH, and acute myocardial injury. There were 312 (45.8%) patients with cardiovascular disease, of whom 23.4% died. β-blockers, ACEI/ARB, arbidol, and ribavirin might have a beneficial effect for severe COVID-19 patients with cardiovascular disease.

Conclusion: The combination of NLR and acute myocardial injury on admission was highly predictive of mortality and survival. Clinicians should adopt more aggressive strategies for patients with a high NLR (>6.66) combined with myocardial injury. β-blockers and ACEI/ARB, as well as arbidol and ribavirin, were effective in COVID-19 patients with cardiovascular disease.

Keywords: COVID-19; Cardiovascular disease; Clinical characteristics; SARS-CoV-2; Treatments.

Fig. 1

ROC analysis of the association between NLR, Acute myocardial injury, and their combination effect in relation to death. A. The ROC curves of age, CRP, LDH, NLR, lymphocyte counts, and acute myocardial injury. B. The ROC curves of NLR, acute myocardial injury, and their combination.