Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study
Open accessAbstract
Objective: To delineate the clinical characteristics of patients with coronavirus disease 2019 (covid-19) who died. Design: Retrospective case series. Setting: Tongji Hospital in Wuhan, China. Participants: Among a cohort of 799 patients, 113 who died and 161 who recovered with a diagnosis of covid-19 were analysed. Data were collected until 28 February 2020. Main outcome measures: Clinical characteristics and laboratory findings were obtained from electronic medical records with data collection forms. Results: The median age of deceased patients (68 years) was significantly older than recovered patients (51 years). Male sex was more predominant in deceased patients (83; 73%) than in recovered patients (88; 55%). Chronic hypertension and other cardiovascular comorbidities were more frequent among deceased patients (54 (48%) and 16 (14%)) than recovered patients (39 (24%) and 7 (4%)). Dyspnoea, chest tightness, and disorder of consciousness were more common in deceased patients (70 (62%), 55 (49%), and 25 (22%)) than in recovered patients (50 (31%), 48 (30%), and 1 (1%)). The median time from disease onset to death in deceased patients was 16 (interquartile range 12.0-20.0) days. Leukocytosis was present in 56 (50%) patients who died and 6 (4%) who recovered, and lymphopenia was present in 103 (91%) and 76 (47%) respectively. Concentrations of alanine aminotransferase, aspartate aminotransferase, creatinine, creatine kinase, lactate dehydrogenase, cardiac troponin I, N-terminal pro-brain natriuretic peptide, and D-dimer were markedly higher in deceased patients than in recovered patients. Common complications observed more frequently in deceased patients included acute respiratory distress syndrome (113; 100%), type I respiratory failure (18/35; 51%), sepsis (113; 100%), acute cardiac injury (72/94; 77%), heart failure (41/83; 49%), alkalosis (14/35; 40%), hyperkalaemia (42; 37%), acute kidney injury (28; 25%), and hypoxic encephalopathy (23; 20%). Patients with cardiovascular comorbidity were more likely to develop cardiac complications. Regardless of history of cardiovascular disease, acute cardiac injury and heart failure were more common in deceased patients. Conclusion: Severe acute respiratory syndrome coronavirus 2 infection can cause both pulmonary and systemic inflammation, leading to multi-organ dysfunction in patients at high risk. Acute respiratory distress syndrome and respiratory failure, sepsis, acute cardiac injury, and heart failure were the most common critical complications during exacerbation of covid-19.
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COVID-19 may affect other major body organs, including renal, cardiovascular, and central nervous systems.
“subsequent reports showed that COVID-19 may also affect other major body organs, including renal, cardiovascular, and central nervous systems (CNS) [16, 125, 128].”
From Cognitive decline following acute viral infections: literature review and projections for post-COVID-19 (2022) · cites this paper as [16]
Many neurological symptoms associated with CoV-2 infection, such as stroke or altered consciousness, are consistent with underlying vasculopathy.
“Multiple immunostaining studies reveal that ACE2 protein in the human brain is predominantly or exclusively expressed in vasculature (and specifically expressed within pericytes) (52, 53, 70), and many neurological symptoms associated with CoV-2 infection like stroke or altered consciousness are consistent with an underlying vasculopathy (71-76).”
From Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia (2020) · cites this paper as [75]
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- Authors
- Chen, T., Wu, D., Chen, H., Yan, W., Yang, D., Chen, G., Ma, K., Xu, D., Yu, H., Wang, H., Wang, T., Guo, W., Chen, J., Ding, C., Zhang, X., Huang, J., Han, M., Li, S., Luo, X., Zhao, J., & Ning, Q.
- Affiliations
- Tongji Hospital (CN)
- Corresponding author
- Ning, Qin
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2020-03-26
- Volume
- 368
- Pages
- m1091
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC7190011
- OpenAlex
- W3012849736
- Cited by
- 3,903
- References
- 20
- Citations by year
- 2026: 20 · 2025: 79 · 2024: 190 · 2023: 320 · 2022: 577 · 2021: 1157 · 2020: 1554 · 2019: 2 · 2013: 2
- FWCI
- 118.39
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-03-31)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Tongji University
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, mortality, deceased patients, clinical features, acute respiratory distress syndrome, sepsis, acute cardiac injury, heart failure, lymphopenia, leukocytosis, D-dimer, cardiac troponin I, N-terminal pro-brain natriuretic peptide, cardiovascular comorbidity, disease severity, prognostic factors, SARS-CoV
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, COVID-19 Testing, COVID-19 Drug Treatment, Adult, Age Factors, Aged, Cardiovascular Diseases, China, Consciousness Disorders, Dyspnea, Female, Humans, Inflammation, Male, Middle Aged, Pneumonia, Viral, Respiration Disorders, Retrospective Studies, Risk Factors, Sex Factors, Time Factors, Biomarkers, Comorbidity, Treatment Outcome, Coronavirus Infections, Clinical Laboratory Techniques, Pandemics
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