Analysis of factors for disease progression in 61 patients with COVID-19 in Xiaogan, Hubei, China.

OBJECTIVE: The aim of this study was to retrospectively analyze clinical characteristics and laboratory results of the novel coronavirus pneumonia (COVID-19) patients so as to identify factors related to disease progression. PATIENTS AND METHODS: Sixty-one patients with COVID-19 were divided into two groups: an improvement/stabilization group (n = 53) and a progression group (n = 8). Clinical data were collected to analyze and compare the differences between the two groups. RESULTS: Of the sixty-one patients, thirty-one were male (50.8%), and thirty were female (49.2%), with a median age of 53 years. On admission, significant differences were observed between the two groups with respect to the levels of Creatine Kinase (CK), lymphocytes, D-dimer and creatinine, and prothrombin time (PT). Univariate logistic regression analysis showed that Platelet-to-lymphocyte ratio (PLR), lymphocytes, Mean platelet volume to lymphocyte ratio (MPVLR), CK, White Blood count to mean platelet volume ratio (WMR), Lymphocyte-to-monocyte ratio (LMR), and serum creatinine were important factors for disease progression. Multivariate logistic regression analysis showed that PLR was an independent factor for disease progression in COVID-19 patients. The receiver operating characteristic (ROC) curve revealed that the best predictor of disease progression was CK. Dynamic changes in the laboratory indicators of patients were tracked, and significant differences were found in the variation trends of white blood cell count, neutrophil count, and WMR, which gradually increased in the progression group, but gradually decreased in the improvement/stabilization group. CONCLUSIONS: Risk factors for disease progression included PLR, lymphocytes, MPVLR, CK, WMR, LMR, and creatinine, among which, PLR is an independent risk factor for disease progression in COVID-19 patients.

[A pathological report of three COVID-19 cases by minimal invasive autopsies].

Objective: To investigate the pathological characteristics and the clinical significance of novel coronavirus (2019-nCoV)-infected pneumonia (termed by WHO as coronavirus disease 2019, COVID-19). Methods: Minimally invasive autopsies from lung, heart, kidney, spleen, bone marrow, liver, pancreas, stomach, intestine, thyroid and skin were performed on three patients died of novel coronavirus pneumonia in Chongqing, China. Hematoxylin and eosin staining (HE), transmission electron microcopy, and histochemical staining were performed to investigate the pathological changes of indicated organs or tissues. Immunohistochemical staining was conducted to evaluate the infiltration of immune cells as well as the expression of 2019-nCoV proteins. Real time PCR was carried out to detect the RNA of 2019-nCoV. Results: Various damages were observed in the alveolar structure, with minor serous exudation and fibrin exudation. Hyaline membrane formation was observed in some alveoli. The infiltrated immune cells in alveoli were majorly macrophages and monocytes. Moderate multinucleated giant cells, minimal lymphocytes, eosinophils and neutrophils were also observed. Most of infiltrated lymphocytes were CD4-positive T cells. Significant proliferation of type Ⅱ alveolar epithelia and focal desquamation of alveolar epithelia were also indicated. The blood vessels of alveolar septum were congested, edematous and widened, with modest infiltration of monocytes and lymphocytes. Hyaline thrombi were found in a minority of microvessels. Focal hemorrhage in lung tissue, organization of exudates in some alveolar cavities, and pulmonary interstitial fibrosis were observed. Part of the bronchial epithelia were exfoliated. Coronavirus particles in bronchial mucosal epithelia and type Ⅱ alveolar epithelia were observed under electron microscope. Immunohistochemical staining showed that part of the alveolar epithelia and macrophages were positive for 2019-nCoV antigen. Real time PCR analyses identified positive signals for 2019-nCoV nucleic acid. Decreased numbers of lymphocyte, cell degeneration and necrosis were observed in spleen. Furthermore, degeneration and necrosis of parenchymal cells, formation of hyaline thrombus in small vessels, and pathological changes of chronic diseases were observed in other organs and tissues, while no evidence of coronavirus infection was observed in these organs. Conclusions: The lungs from novel coronavirus pneumonia patients manifest significant pathological lesions, including the alveolar exudative inflammation and interstitial inflammation, alveolar epithelium proliferation and hyaline membrane formation. While the 2019-nCoV is mainly distributed in lung, the infection also involves in the damages of heart, vessels, liver, kidney and other organs. Further studies are warranted to investigate the mechanism underlying pathological changes of this disease.