ABSTRACT
Objective To investigate the clinical features of and contributing factors in 13 fatal cases of Coronavirus Disease 2019 (COVID-19).Methods The clinical data of 13 patients who died of COVID-19 in Central Theater General hospital, China, between January 4, 2020, and February 24, 2020, were analyzed retrospectively. The data reviewed included clinical manifestations, laboratory test results and radiographic features. The cellular immune function and the expression of inflammatory factors in deceased patients at different stages of the disease were analyzed, and the clinical data and laboratory test results between the deceased group and the moderate group (20 patients), severe group (20 patients) and the critical group (10 patients) were compared.Results Of those who died, the patients consisted of 10 men and 3 women. The average age of those who died was (74±19) years, and 10 patients were over 70 years old (76.9%), which was significantly higher than the ages of patients in the moderate group, severe group and critical group. There were no significant differences in sex ratio and clinical manifestations among the 4 groups. For the patients who died, 9presented with underlying diseases,6 of whom had more than 2 diseases, which was significantly higher than the number of underlying disease in the other groups. On admission, the chest computed tomography (CT) for 8 patients (61.5%) mainly showed multiple patchy ground-glass opacities. When the disease progressed, the ground-glass opacities rapidly developed into diffuse lesions in both lungs. The lymphocyte and CD3 + ,CD4 + , and CD8 + T lymphocyte counts in the peripheral blood of 13 patients were significantly lower than normal levels and decreased more substantially during the disease course based on the levels when admitted (P<0.01). Additionally, the IL-6, D-dimer, C-reactive protein (CRP), lactic acid levels gradually increased, and most peaked before death. There were statistically significant differences in IL-6 expression, lymphocyte count and T lymphocyte subset count between the deceased group and the moderate group, severe group and critical group (P<0.01). However, there were no statistically significant differences in serum CRP lactic acid levels among the 4 groups (P>0.05).The cause of death for most patients was acute respiratory distress syndrome (ARDS) with type I respiratory failure. Three patients eventually developed multiorgan deficiency syndrome (MODS).Conclusion The risk factors of death for COVID-19 patients included older men, more underlying diseases, poor cellular immune function and overexpression of inflammatory factors. The main cause of death in patients with COVID-19 was ARDS, which led to respiratory failure and MODS.