RESUMEN
Objective:To analyze the clinical features of severe or critical 2019 novel coronavirus pneumonia (NCP) patients.Methods:Clinical data of 58 patients with severe or critical NCP in Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 29 to February 26, 2020 were collected. The general information, clinical symptoms, results of blood test and chest computed tomography (CT) imagings, treatments and outcomes of patients were analyzed retrospectively.Results:Among the 58 patients, 36 patients (62.1%) were severe and 22 (37.9%) were critical, 28 (48.3%) were male and 30 (51.7%) female, with an average age of (62.12±12.95) years. Twenty-eight patients (48.2%) had previous underlying diseases, including 21 patients (36.2%) with hypertension, 11 patients (19.0%) with diabetes mellitus, 6 patietns (10.3%) with coronary heart disease, 2 patients (3.4%) with chronic renal failure, and 1 patient (1.7%) with malignant tumor. The symptoms included fever (54 cases, 93.1%), dyspnea (48 cases, 82.8%), cough (46 cases, 79.3%), muscle soreness (32 cases, 55.2%), sore throat (15 cases, 25.9%), and diarrhea (6 cases, 10.3%). Decreased or increased white blood cell count was found in 7 patients (12.1%) and 6 patietns (10.3%). Decreased percent of lymphocyte, increased percent of neutrophil, and decreased hemoglobin level were found in 35 patients (60.3%), 27 patients (46.6%), and 24 patients (41.4%), respectively. Elevated CRP, PCT and D-dimmer level were demonstrated in 38 patients (65.5%), 36 patients (62.1%), and 45 patients (77.5%). Increased level of ALT, AST, LDH and decreased serum albumin were found in 32 patients (55.2%), 25 patients (43.1%), 39 patietns (67.2%) and 43 patietns (74.1%), respectively. The main features of CT imaging were diffuse lesion in both lungs, which were mainly manifested as multiple patchy shadows and ground-glass shadows, bilateral and peripheral distribution, consolidation and interlobular septal thickening. Twenty-nine patients (50.0%) were treated with antibiotics, and 14 patients (24.1%) with systemic glucocorticoid. In addition to supportive and antivirus treatment, oxygen therapy methods including nasal catheter (9 cases, 15.5%), oxygen mask (33 cases, 56.9%), high-flow nasal catheter (8 cases, 13.3%) and invasive mechanical ventilation were adopted. Twenty-one patients (36.2%) were discharged from the hospital, 27 patients (46.6%) in remission were still in the isolation wards, 3 patients (5.2%) were transferred to the ICU for further treatment, and 7 patients (12.1%) died.Conclusions:Severe and critical NCP are at higher risk in the elderly and those having underlying diseases. Severe/critical NCP patients often show extrapulmonary abnormity as well as lung dysfunction. Comprehensive treatment as early as possible is the key to improve the prognosis and reduce the mortality.