Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study
Open accessAbstract
Background An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia.Methods In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation.Findings Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3-11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients.Interpretation The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1-2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced.Funding None.
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Four fungal pathogens were identified from three studies; Candida albicans was isolated from the respiratory tract in five patients and urinary tract of a sixth.
“Four fungal pathogens were identified from three studies.10 , 23 , 35 Candida albicans was isolated from the respiratory tract in five patients and urinary tract of a sixth.”
From Co-infections in people with COVID-19: a systematic review and meta-analysis. (2020) · cites this paper as [35]
One study reported detection of ESBL-positive K. pneumoniae, ESBL-positive P. aeruginosa, and carbapenem-resistant K. pneumoniae in patients on ICU.
“one study reported the detection of extended spectrum β-lactamase (ESBL)-positive K.pneumoniae, ESBL-positive P.aeruginosa, and carbapenem-resistant K.pneumoniae in patients on ICU.35”
From Co-infections in people with COVID-19: a systematic review and meta-analysis. (2020) · cites this paper as [35]
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- Authors
- Yang, X., Yu, Y., Xu, J., Shu, H., Xia, J., Liu, H., Wu, Y., Zhang, L., Yu, Z., Fang, M., Yu, T., Wang, Y., Pan, S., Zou, X., Yuan, S., & Shang, Y.
- Affiliations
- Jinyintan Hospital (CN)
- Huazhong University of Science and Technology (CN)
- Hubei University of Arts and Science (CN)
- Renmin Hospital of Wuhan University (CN)
- Tongji Hospital (CN)
- Corresponding author
- Shang, You
- ORCID
- Venue
- The Lancet Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 8
- Issue
- 5
- Pages
- 475-481
- ISSN
- 2213-2600 (ISSN-L)
- PMC
- PMC7102538
- OpenAlex
- W3008090866
- Cited by
- 10,066
- References
- 23
- Citations by year
- 2026: 72 · 2025: 185 · 2024: 513 · 2023: 886 · 2022: 1566 · 2021: 2788 · 2020: 4029 · 2019: 7 · 2018: 3 · 2015: 2 · 2013: 2 · 2012: 4
- FWCI
- 304.06
- Type
- journal article
- Language
- en
- Update notices
- erratum (2020-04-01)
- Open access
- bronze
- doi.org
- Locations
- The Lancet Respiratory Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pneumonia, COVID-19 pandemic, critically ill patients, intensive care unit, 28-day mortality, acute respiratory distress syndrome, mechanical ventilation, organ dysfunction, acute kidney injury, cardiac injury, liver dysfunction, clinical outcomes, Wuhan outbreak, comorbidities, mortality risk factors, prognostic factors, prognostic score
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adult, Aged, Aged, 80 and over, China, Female, Humans, Intensive Care Units, Male, Middle Aged, Pneumonia, Viral, Respiration, Artificial, Respiratory Distress Syndrome, Retrospective Studies, Critical Illness, Treatment Outcome, Coronavirus Infections, Pandemics
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