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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The clinical data from 19 critically ill patients with coronavirus disease 2019: a single-centered, retrospective, observational study</title><author><name sortKey="Zhang, Jinping" sort="Zhang, Jinping" uniqKey="Zhang J" first="Jinping" last="Zhang">Jinping Zhang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Liu, Peng" sort="Liu, Peng" uniqKey="Liu P" first="Peng" last="Liu">Peng Liu</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.49470.3e</institution-id><institution-id institution-id-type="ISNI">0000 0001 2331 6153</institution-id><institution>State Key Laboratory of Virology and Hubei Province Key Laboratory of Allergy and Immune-related Diseases,</institution><institution>Department of Immunology, Wuhan University School of Basic Medical Sciences,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Wang, Morong" sort="Wang, Morong" uniqKey="Wang M" first="Morong" last="Wang">Morong Wang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Wang, Jie" sort="Wang, Jie" uniqKey="Wang J" first="Jie" last="Wang">Jie Wang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Chen, Jie" sort="Chen, Jie" uniqKey="Chen J" first="Jie" last="Chen">Jie Chen</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Yuan, Wenling" sort="Yuan, Wenling" uniqKey="Yuan W" first="Wenling" last="Yuan">Wenling Yuan</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Li, Mei" sort="Li, Mei" uniqKey="Li M" first="Mei" last="Li">Mei Li</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Xie, Zhijuan" sort="Xie, Zhijuan" uniqKey="Xie Z" first="Zhijuan" last="Xie">Zhijuan Xie</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Dong, Wangping" sort="Dong, Wangping" uniqKey="Dong W" first="Wangping" last="Dong">Wangping Dong</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Li, Hongye" sort="Li, Hongye" uniqKey="Li H" first="Hongye" last="Li">Hongye Li</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Zhao, Yan" sort="Zhao, Yan" uniqKey="Zhao Y" first="Yan" last="Zhao">Yan Zhao</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Wan, Lun" sort="Wan, Lun" uniqKey="Wan L" first="Lun" last="Wan">Lun Wan</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Chu, Tian" sort="Chu, Tian" uniqKey="Chu T" first="Tian" last="Chu">Tian Chu</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Wang, Lu" sort="Wang, Lu" uniqKey="Wang L" first="Lu" last="Wang">Lu Wang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Zhang, Hui" sort="Zhang, Hui" uniqKey="Zhang H" first="Hui" last="Zhang">Hui Zhang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Tao, Ting" sort="Tao, Ting" uniqKey="Tao T" first="Ting" last="Tao">Ting Tao</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Ma, Jing" sort="Ma, Jing" uniqKey="Ma J" first="Jing" last="Ma">Jing Ma</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32318325</idno><idno type="pmc">7171052</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171052</idno><idno type="RBID">PMC:7171052</idno><idno type="doi">10.1007/s10389-020-01291-2</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000133</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000133</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The clinical data from 19 critically ill patients with coronavirus disease 2019: a single-centered, retrospective, observational study</title><author><name sortKey="Zhang, Jinping" sort="Zhang, Jinping" uniqKey="Zhang J" first="Jinping" last="Zhang">Jinping Zhang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Liu, Peng" sort="Liu, Peng" uniqKey="Liu P" first="Peng" last="Liu">Peng Liu</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.49470.3e</institution-id><institution-id institution-id-type="ISNI">0000 0001 2331 6153</institution-id><institution>State Key Laboratory of Virology and Hubei Province Key Laboratory of Allergy and Immune-related Diseases,</institution><institution>Department of Immunology, Wuhan University School of Basic Medical Sciences,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Wang, Morong" sort="Wang, Morong" uniqKey="Wang M" first="Morong" last="Wang">Morong Wang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Wang, Jie" sort="Wang, Jie" uniqKey="Wang J" first="Jie" last="Wang">Jie Wang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Chen, Jie" sort="Chen, Jie" uniqKey="Chen J" first="Jie" last="Chen">Jie Chen</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Yuan, Wenling" sort="Yuan, Wenling" uniqKey="Yuan W" first="Wenling" last="Yuan">Wenling Yuan</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Li, Mei" sort="Li, Mei" uniqKey="Li M" first="Mei" last="Li">Mei Li</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Xie, Zhijuan" sort="Xie, Zhijuan" uniqKey="Xie Z" first="Zhijuan" last="Xie">Zhijuan Xie</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Dong, Wangping" sort="Dong, Wangping" uniqKey="Dong W" first="Wangping" last="Dong">Wangping Dong</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Li, Hongye" sort="Li, Hongye" uniqKey="Li H" first="Hongye" last="Li">Hongye Li</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Zhao, Yan" sort="Zhao, Yan" uniqKey="Zhao Y" first="Yan" last="Zhao">Yan Zhao</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Wan, Lun" sort="Wan, Lun" uniqKey="Wan L" first="Lun" last="Wan">Lun Wan</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Chu, Tian" sort="Chu, Tian" uniqKey="Chu T" first="Tian" last="Chu">Tian Chu</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Wang, Lu" sort="Wang, Lu" uniqKey="Wang L" first="Lu" last="Wang">Lu Wang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Zhang, Hui" sort="Zhang, Hui" uniqKey="Zhang H" first="Hui" last="Zhang">Hui Zhang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Tao, Ting" sort="Tao, Ting" uniqKey="Tao T" first="Ting" last="Tao">Ting Tao</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author><author><name sortKey="Ma, Jing" sort="Ma, Jing" uniqKey="Ma J" first="Jing" last="Ma">Jing Ma</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</nlm:aff></affiliation></author></analytic><series><title level="j">Zeitschrift Fur Gesundheitswissenschaften</title><idno type="ISSN">2198-1833</idno><idno type="eISSN">1613-2238</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p id="Par1">The objectives of this study were to analyze the clinical features of coronavirus disease 2019 (COVID-19) and evaluate the diagnosis and treatment.</p></sec><sec><title>Methods</title><p id="Par2">A retrospective analysis of the clinical manifestation and auxiliary examination of 19 patients with COVID-19 from the Liyuan Hospital intensive care unit (ICU) between January 16, 2020 and February 20, 2020 was undertaken.</p></sec><sec><title>Results</title><p id="Par3">There were 11 male and 8 female cases among the patients. The median (range) age was 73 (38–91) years. Of these patients, 8 (42.1%) had died and the median duration from ICU admission to death was 2 (interquartile range (IQR): 1–10.75) days. Seven of these 8 patients had underlying diseases. The auxiliary examination showed fever (68.4%), dry cough (15.8%), dyspnea (10.5%), and diarrhea (5.3%). All 19 cases showed ground-glass changes on chest computed tomography. Serum hypersensitive C-reactive protein (hs-CRP) and serum amylase A (SAA) were clearly increased in all of the cases. Among the 19 cases, there were 16 (84.2%) cases in which the total number of lymphocytes decreased, 12 cases (63%) had reduced liver function, and 11 cases (58%) had deviant results for fibrinogen (FIB) and D-dimer, in particular, the D-dimer level was significantly higher in the non-survivors compared with the survivors.</p></sec><sec><title>Conclusion</title><p id="Par4">There were more men than women among critically ill patients. All of the cases showed ground-glass changes on chest computed tomography and the vast majority of patients displayed fever and dry cough. The clinical laboratory indices change significantly, especially the D-dimer level among non-survivors.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Chen, N" uniqKey="Chen N">N Chen</name></author><author><name sortKey="Zhou, M" uniqKey="Zhou M">M Zhou</name></author><author><name sortKey="Dong, X" uniqKey="Dong X">X Dong</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chung, M" uniqKey="Chung M">M Chung</name></author><author><name sortKey="Bernheim, A" uniqKey="Bernheim A">A Bernheim</name></author><author><name sortKey="Mei, X" uniqKey="Mei X">X Mei</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cui, J" uniqKey="Cui J">J Cui</name></author><author><name sortKey="Li, F" uniqKey="Li F">F Li</name></author><author><name sortKey="Shi, Zl" uniqKey="Shi Z">ZL Shi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Holshue, Ml" uniqKey="Holshue M">ML Holshue</name></author><author><name sortKey="Debolt, C" uniqKey="Debolt C">C DeBolt</name></author><author><name sortKey="Lindquist, S" uniqKey="Lindquist S">S Lindquist</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Honce, R" uniqKey="Honce R">R Honce</name></author><author><name sortKey="Schultz Cherry, S" uniqKey="Schultz Cherry S">S Schultz-Cherry</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huang, C" uniqKey="Huang C">C Huang</name></author><author><name sortKey="Wang, Y" uniqKey="Wang Y">Y Wang</name></author><author><name sortKey="Li, X" uniqKey="Li X">X Li</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Li, S" uniqKey="Li S">S Li</name></author><author><name sortKey="Li, H" uniqKey="Li H">H Li</name></author><author><name sortKey="Xu, X" uniqKey="Xu X">X Xu</name></author><author><name sortKey="Saw, Pe" uniqKey="Saw P">PE Saw</name></author><author><name sortKey="Zhang, L" uniqKey="Zhang L">L Zhang</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Z Gesundh Wiss</journal-id><journal-id journal-id-type="iso-abbrev">Z Gesundh Wiss</journal-id><journal-title-group><journal-title>Zeitschrift Fur Gesundheitswissenschaften</journal-title></journal-title-group><issn pub-type="ppub">2198-1833</issn><issn pub-type="epub">1613-2238</issn><publisher><publisher-name>Springer Berlin Heidelberg</publisher-name><publisher-loc>Berlin/Heidelberg</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32318325</article-id><article-id pub-id-type="pmc">7171052</article-id><article-id pub-id-type="publisher-id">1291</article-id><article-id pub-id-type="doi">10.1007/s10389-020-01291-2</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>The clinical data from 19 critically ill patients with coronavirus disease 2019: a single-centered, retrospective, observational study</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" equal-contrib="yes"><name><surname>Zhang</surname><given-names>Jinping</given-names></name><address><email>zhangjinping0425@163.com</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Liu</surname><given-names>Peng</given-names></name><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Morong</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Jie</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Chen</surname><given-names>Jie</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Yuan</surname><given-names>Wenling</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>Mei</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Xie</surname><given-names>Zhijuan</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Dong</surname><given-names>Wangping</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>Hongye</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Zhao</surname><given-names>Yan</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Wan</surname><given-names>Lun</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Chu</surname><given-names>Tian</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Lu</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Zhang</surname><given-names>Hui</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Tao</surname><given-names>Ting</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Ma</surname><given-names>Jing</given-names></name><address><email>jiaositang@163.com</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="GRID">grid.33199.31</institution-id><institution-id institution-id-type="ISNI">0000 0004 0368 7223</institution-id><institution>ICU, Liyuan Hospital affiliated to Tongji Medical College,</institution><institution>Huazhong University of Science and Technology,</institution></institution-wrap>Wuhan, 430071 China</aff><aff id="Aff2"><label>2</label><institution-wrap><institution-id institution-id-type="GRID">grid.49470.3e</institution-id><institution-id institution-id-type="ISNI">0000 0001 2331 6153</institution-id><institution>State Key Laboratory of Virology and Hubei Province Key Laboratory of Allergy and Immune-related Diseases,</institution><institution>Department of Immunology, Wuhan University School of Basic Medical Sciences,</institution></institution-wrap>Wuhan, 430071 China</aff></contrib-group><pub-date pub-type="epub"><day>21</day><month>4</month><year>2020</year></pub-date><fpage>1</fpage><lpage>4</lpage><history><date date-type="received"><day>15</day><month>3</month><year>2020</year></date><date date-type="accepted"><day>2</day><month>4</month><year>2020</year></date></history><permissions><copyright-statement>© Springer-Verlag GmbH Germany, part of Springer Nature 2020</copyright-statement><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p id="Par1">The objectives of this study were to analyze the clinical features of coronavirus disease 2019 (COVID-19) and evaluate the diagnosis and treatment.</p></sec><sec><title>Methods</title><p id="Par2">A retrospective analysis of the clinical manifestation and auxiliary examination of 19 patients with COVID-19 from the Liyuan Hospital intensive care unit (ICU) between January 16, 2020 and February 20, 2020 was undertaken.</p></sec><sec><title>Results</title><p id="Par3">There were 11 male and 8 female cases among the patients. The median (range) age was 73 (38–91) years. Of these patients, 8 (42.1%) had died and the median duration from ICU admission to death was 2 (interquartile range (IQR): 1–10.75) days. Seven of these 8 patients had underlying diseases. The auxiliary examination showed fever (68.4%), dry cough (15.8%), dyspnea (10.5%), and diarrhea (5.3%). All 19 cases showed ground-glass changes on chest computed tomography. Serum hypersensitive C-reactive protein (hs-CRP) and serum amylase A (SAA) were clearly increased in all of the cases. Among the 19 cases, there were 16 (84.2%) cases in which the total number of lymphocytes decreased, 12 cases (63%) had reduced liver function, and 11 cases (58%) had deviant results for fibrinogen (FIB) and D-dimer, in particular, the D-dimer level was significantly higher in the non-survivors compared with the survivors.</p></sec><sec><title>Conclusion</title><p id="Par4">There were more men than women among critically ill patients. All of the cases showed ground-glass changes on chest computed tomography and the vast majority of patients displayed fever and dry cough. The clinical laboratory indices change significantly, especially the D-dimer level among non-survivors.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Coronavirus disease 2019</kwd><kwd>Clinical manifestations</kwd><kwd>Epidemiology</kwd><kwd>Retrospective</kwd><kwd>D-dimer</kwd></kwd-group></article-meta></front><body><sec id="Sec1" sec-type="introduction"><title>Introduction</title><p id="Par5">Since December 2019, an outbreak of unexplained pneumonia in Wuhan, China, has spread rapidly to other provinces in China and around the world (Chen et al. <xref ref-type="bibr" rid="CR1">2020</xref>; Holshue et al. <xref ref-type="bibr" rid="CR4">2020</xref>). Studies have indicated that it is a novel coronavirus pneumonia, which was named coronavirus disease 2019 (COVID-19). As of February 24, 2020, the total number of patients has risen sharply to 77,262 in China, with 2595 (3.2%) who have died. The main diagnosis method is the pathogenic results obtained by quantitative real-time polymerase chain reaction (qRT-PCR), which proved to be highly homologous with known genetic sequencing. However, the positivity rate is 30–50%, due to the influence of individual factors, the onset time, and specimen collection. It is very important to discover the specific information characterizing critically ill patients (Chung et al. <xref ref-type="bibr" rid="CR2">2020</xref>; Xie et al. <xref ref-type="bibr" rid="CR10">2020</xref>). Therefore, we conducted a retrospective analysis of critically ill patients with COVID-19.</p></sec><sec id="Sec2" sec-type="materials|methods"><title>Methods</title><p id="Par6">All of the COVID-19 cases in this study came from the Liyuan Hospital intensive care unit (ICU) of Tongji Medical College, Huazhong University of Science and Technology, during the period January 16, 2020 to February 20, 2020.</p><p id="Par7">According to the World Health Organization’s (WHO) interim guidance, a severely ill patient is defined as one with any of the following symptoms:<list list-type="order"><list-item><p id="Par8">Respiratory distress, respiratory rate (RR) acuity of 30 breaths/min.</p></list-item><list-item><p id="Par9">Oxygen saturation during resting state of 93% or less.</p></list-item><list-item><p id="Par10">Arterial blood oxygen partial pressure (PaO<sub>2</sub>)/(FiO<sub>2</sub>) ≤ 300 mmHg (high-altitude region (more than 1000 m above sea level, according to the following formula for correction: PaO<sub>2</sub>/FiO<sub>2</sub> × 760 (mmHg)/atmosphere)).</p></list-item></list></p><p id="Par11">Critically ill patients are defined as those with any of the characteristics:<list list-type="order"><list-item><p id="Par12">Respiratory failure and need for mechanical ventilation.</p></list-item><list-item><p id="Par13">Shock.</p></list-item><list-item><p id="Par14">Combination of failure of other organ functions, followed by the need for ICU admission.</p></list-item></list></p><p id="Par15">We collected data on age, sex, underlying diseases (chronic pulmonary disease, chronic cardiac disease, cerebrovascular disease, diabetes, etc), symptoms, vital signs (heart rate, blood pressure, respiratory rate, etc.), and laboratory values (blood, routine urine test, liver function, renal function, electrolyte and myocardial enzymes, troponin, coagulation function, hypersensitive C-reactive protein (hs-CRP), and serum amylase A (SAA)).</p></sec><sec id="Sec3" sec-type="results"><title>Results</title><p id="Par16">Among the COVID-19 patients, there were 11 males and 8 females. Their median (range) age was 73 (38–91) years. Of these patients, 8 (42.1%) died and the median duration from ICU admission to death was 2 (interquartile range (IQR): 1–10.75) days. Fifteen (78.9%) patients had underlying diseases, mainly high blood pressure or diabetes. Seven of the patients who died had underlying diseases. All of the patients were citizens of Wuhan, China, and had no history of contact with COVID-19 (Table <xref rid="Tab1" ref-type="table">1</xref>).<table-wrap id="Tab1"><label>Table 1</label><caption><p>Characteristics of the study population</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Groups</th><th colspan="3">Critically ill patients (<italic>n</italic> = 19)</th></tr><tr><th>Survivors (<italic>n</italic> = 11)</th><th>Non-survivors (<italic>n</italic> = 8)</th><th>All patients (<italic>n</italic> = 19)</th></tr></thead><tbody><tr><td>Age, median (range)</td><td>68 (38–87)</td><td>77 (66–91)</td><td>73 (38–91)</td></tr><tr><td>Males/females</td><td>6/5</td><td>5/3</td><td>11/8</td></tr><tr><td>Clinical symptoms</td><td>11/11</td><td>8/8</td><td>19/19</td></tr><tr><td>Chest CT (positive/tested)</td><td>11/11</td><td>8/8</td><td>19/19</td></tr><tr><td>qRT-PCR assay (positive/tested)</td><td>10/11</td><td>3/8</td><td>13/19</td></tr><tr><td>Hypertension</td><td>6/11</td><td>5/8</td><td>11/19</td></tr><tr><td>Diabetes</td><td>1/11</td><td>3/8</td><td>4/19</td></tr><tr><td>Chronic bronchitis</td><td>3/11</td><td>0/8</td><td>3/19</td></tr><tr><td>Chronic cardiac disease</td><td>0/11</td><td>3/8</td><td>3/19</td></tr><tr><td>Cerebrovascular disease</td><td>1/11</td><td>2/8</td><td>3/19</td></tr></tbody></table><table-wrap-foot><p>COVID-19 clinical symptoms include fever, cough, and lacking in strength</p></table-wrap-foot></table-wrap></p><p id="Par17">Clinical manifestations included fever (13/19, 68.4%), dry cough (3/19, 15.8%), dyspnea (2/19, 10.5%), and diarrhea (1/19, 5.3%). Seven patients were treated by intubation and mechanical ventilation.</p><p id="Par18">Auxiliary examination showed that all 19 cases (100%) showed ground-glass changes on chest computed tomography (CT). The clinical laboratory indices were as follows: the infection indices (hs-CRP and SAA) were clearly increased in all 19 cases; there were 16 cases (84.2%) in which the total number of lymphocytes decreased; 12 cases (63%) had decreased liver function; 11 cases (58%) had deviant results for fibrinogen (FIB) and D-dimer, in particular, the increase in the D-dimer level was significantly higher among the non-survivors (<italic>n</italic> = 8, 100%) compared to the survivors (<italic>n</italic> = 11, 27%); 9 cases (47%) had deviant levels of cardiac muscle enzymes and troponin T (Table <xref rid="Tab2" ref-type="table">2</xref>).<table-wrap id="Tab2"><label>Table 2</label><caption><p>Symptoms and clinical laboratory index results of critically ill patients with COVID-19 pneumonia</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Groups</th><th colspan="3">Critically ill patients (<italic>n</italic> = 19)</th></tr><tr><th>Survivors (<italic>n</italic> = 11)</th><th>Non-survivors (<italic>n</italic> = 8)</th><th>All patients (<italic>n</italic> = 19)</th></tr></thead><tbody><tr><td colspan="4">Symptoms</td></tr><tr><td> Fever</td><td>7/11</td><td>6/8</td><td>13/19</td></tr><tr><td> Cough</td><td>5/11</td><td>3/8</td><td>8/19</td></tr><tr><td> Lacking in strength</td><td>2/11</td><td>0/8</td><td>2/19</td></tr><tr><td> Dyspnea</td><td>0/11</td><td>2/8</td><td>2/19</td></tr><tr><td colspan="4">Clinical laboratory index, median (IQR)</td></tr><tr><td> Hypersensitive C-reactive protein (mg/L)</td><td>86.9 (47.9–120.5)</td><td>166.15 (82.3–129.4)</td><td>95.4 (54.1–120.5)</td></tr><tr><td> Serum amylase A (mg/L)</td><td>65.7 (56.9–100.8)</td><td>95.1 (54.8–79.8)</td><td>64.3 (56.4–94.6)</td></tr><tr><td> Aminotransferase (U/L)</td><td>39.5 (26.4–77.5)</td><td>50.9 (43.2–71.2)</td><td>47.2 (29.7–75.8)</td></tr><tr><td> Albumin (g/L)</td><td>36 (31.8–37.3)</td><td>33.65 (29.2–34.7)</td><td>34.1 (30.9–36.7)</td></tr><tr><td> D-dimer (mg/L FEU)</td><td>0.48 (0.42–0.97)</td><td>2.15 (1.4–9.2)</td><td>0.91 (0.475–2.35)</td></tr></tbody></table><table-wrap-foot><p>COVID-19 clinical symptoms include fever, cough, and lacking in strength</p></table-wrap-foot></table-wrap></p></sec><sec id="Sec4" sec-type="discussion"><title>Discussion</title><p id="Par19">At present, there are no specific drugs for COVID-19, only general supportive therapy and treatment in isolation. For mildly ill patients, the infection usually clears spontaneously. Nevertheless, severe illnesses develop easily, such as acute respiratory distress syndrome (ARDS), multiple system organ failure, or even death. In this study, more men than women and more older than younger individuals made up the group of critically ill patients, and the median (range) age of the 19 patients was 73 (38–91) years. Eight (42.1%) patients died and the median duration from ICU admission to death was 2 (IQR: 1–10.75) days. These results suggest that sex and age are affecting the risk factors. Patients with a history of underlying disease (high blood pressure or diabetes) are at increased risk of becoming critically ill or dying if they have the COVID-19 infection. These findings are consistent with previous reports (Chen et al. <xref ref-type="bibr" rid="CR1">2020</xref>; Huang et al. <xref ref-type="bibr" rid="CR6">2020</xref>). The susceptibility of a population to infection by this new virus drives the dynamics of a pandemic. The clinical manifestations include fever, fatigue, and dry cough without phlegm. A few patients have nasal congestion, runny nose, sore throat, and diarrhea (Cui et al.<xref ref-type="bibr" rid="CR3">2019</xref>; Zhu et al. <xref ref-type="bibr" rid="CR11">2020</xref>). Critically ill patients were more vulnerable to dyspnea, hypoxemia, and even ARDS, irreformable metabolic acidosis, sepsis, and coagulation disturbance after just one week (Wang et al. <xref ref-type="bibr" rid="CR9">2020</xref>). Our study found that the severely ill patients went to the hospital early, at the first signs of symptoms of fever and cough, and the time from showing symptoms to ICU admission was 6.4 days. At the ICU, 18 cases (94.7%) developed ARDS rapidly.</p><p id="Par20">In regards to the laboratory tests, all 19 cases (100%) showed ground-glass changes on chest CT. The vast majority of these clinical laboratory indices changed significantly: the hs-CRP and SAA were clearly increased in all 19 cases (100%); 9 cases (47%) had deviant levels of cardiac muscle enzymes and troponin T; 12 cases (63%) had decreased liver function; 11 cases (58%) had deviant results for FIB and D-dimer, in particular, the increase in the D-dimer level was significantly higher among the non-survivors (<italic>n</italic> = 8, 100%) compared to the survivors (<italic>n</italic> = 11, 27%). This suggested that the D-dimer level can be used to monitor change in the condition of severely ill patients (Fig. <xref rid="Fig1" ref-type="fig">1</xref>). There were 16 (84.2%) cases in which the total number of lymphocytes decreased, which may prompt the theory that COVID-19 infects cells of the human immune system, destroying or impairing their function.<fig id="Fig1"><label>Fig. 1</label><caption><p>Comparison of the D-dimer levels among non-survivors and survivors. *<italic>p</italic> < 0.05 (Mann–Whitney <italic>U</italic>-test)</p></caption><graphic xlink:href="10389_2020_1291_Fig1_HTML" id="MO1"></graphic></fig></p><p id="Par21">Previous studies showed that the coronavirus can induce the body to produce oxidative stress and release a large amount of active oxygen free radicals, which can, on one hand, make the virus replicate unceasingly, but, on the other hand, the excessive free radicals can damage the body’s biological membrane lipid peroxidation, enzyme, amino acid, and oxidative protein, leading to injury to the organs, such as the lung, heart, liver, kidney, etc. (Li et al <xref ref-type="bibr" rid="CR8">2016</xref>; Honce and Schultz-Cherry <xref ref-type="bibr" rid="CR5">2019</xref>; Li et al. <xref ref-type="bibr" rid="CR7">2020</xref>; Zhu et al. <xref ref-type="bibr" rid="CR12">2019</xref>).</p><p id="Par22">COVID-19 belongs to the group of viruses which can easily mutate during the process of RNA replication. As a result, we suspect that the new coronavirus in patients with multiple organ function damage is most likely related to this group. In regards to imaging aspects, 19 cases (100%) showed ground-glass changes on chest CT, which is the best tool to use to evaluate the imaging signs for early diagnosis.</p><p id="Par23">In conclusion, to analyze the clinical features of patients with COVID-19, we found that sex and age are affecting the risk factors. Patients with a history of underlying disease (high blood pressure or diabetes) are at increased risk of becoming critically ill or dying if they have the COVID-19 infection. Chest CT, lymphocyte count, hs-CRP, and SAA can be used in disease diagnosis. The D-dimer level plays an important role in critically ill patients and it is suggested that D-dimer can be used to monitor change in the condition of severely ill patients. There are certain limitations to this study, in that the number of patients was small and it should be classified as a retrospective study. We hope to have more samples in future to carry out a more comprehensive study and elucidate better means for the clinical treatment of COVID-19.</p></sec></body><back><fn-group><fn><p><bold>Publisher’s note</bold></p><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p></fn><fn><p>Jinping Zhang and Peng Liu contributed equally to this work.</p></fn></fn-group><ack><title>Acknowledgements</title><p>We thank the medical staff of Liyuan Hospital for their assistance in collecting the clinical samples.</p></ack><notes notes-type="ethics"><title>Compliance with ethical standards</title><notes notes-type="COI-statement"><title>Conflict of interest</title><p id="Par24">The authors declare that they have no conflicts of interest related to this work. 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