Clinical analysis of nine cases with critical corona virus disease 2019 in Hainan Province / 中华传染病杂志

ABSTRACT

Objective:To explore the clinical features of critical cases of corona virus disease 2019 (COVID-19).Methods:The clinical data of nine patients who were diagnosed with critical COVID-19 in Hainan General Hospital from January 21 to February 6, 2020 were retrospectively analyzed. There were eight males and one female enrolled. The patients aged 28 to 77 years old, with an age of (52.9±18.0) years. Reverse transcription-polymerase chain reaction testing for 2019 novel coronavirus (2019-nCoV) was performed with multi-sites synchronize specimens including pharyngeal swab, blood, excrement and urine. The deadline of follow-up was March 4, 2020. The serum levels of leukocyte, C reactive protein, procalcitonin and lactic acid between the improved group (five cases) and the deteriorated group (four cases) were compared. The t test was used for comparison of normally distributed continuous data between groups. Results:Among nine patients, five cases were cured and discharged, three cases died and one case remained in critical condition. All multi-sites specimens of patients in improved group turned negative in 2 to 4 weeks of illness onset, while those of cases in deteriorated group showed sustained viral nucleic acid positive (up to 48th day of illness onset). The white blood cell counts ((13.52±8.24)×10 9/L vs (10.49±4.46)×10 9/L), C reactive protein ((139.71±87.46) mg/L vs (78.60±55.40) mg/L) and procalcitonin ((4.03±2.32) μg/L vs (0.58±0.28) μg/L), lactic acid ((4.14±3.70) mmol/L vs (2.33±0.53) mmol/L) in deteriorated group were all significantly higher than those in improved group ( t=2.908, 5.009, 4.391 and 2.942, respectively, all P<0.01). A rapid rise of serum interleukin-6 level up to 8 500 ng/L was observed in one patient three days prior to death. Conclusion:Among the patients with critical COVID-19, serum levels of inflammatory cytokines of the death cases are higher than those of improved and discharged cases.