Novel Insights of Illness Evolution And Mortality Risk Profiles for the Non-Survivors with COVID-19

Background: The outbreak of COVID-19 has attracted the attention of the whole world. Our study aims to describe illness evolution and mortality risk profiles for non-survivors. Methods: We retrospectively analyzed 155 patients with COVID-19 in Wuhan and focused on eighteen non-survivors among them. We compared the dynamic profile of laboratory data from hospital admission date to death date of the patients. The survival curve was analyzed by Kaplan-Meier. Findings: Of the non-survivors, the median age was 73·5 years old and the proportion of males was 72·2%. Fifteen individuals had chronic medical illnesses. Five and thirteen patients were hospital-acquired and community-acquired infections, respectively. Five were co-infected with other pathogens. The interval between disease onset and diagnosis was 8·5 days (IQR, [4-11]). With the deterioration of the disease, most patients gradually developed lymphopenia, increased WBC and neutrophil counts, decreased platelet count, decreased total plasma protein and albumin, as well as elevated D-dimer. Notably, procalcitonin were dynamically increased from their admission date to death date. These patients exhibited decreased CD3+T, CD3+CD4+Th, and CD3+CD8+Tc cell count in the peripheral blood. All patients died within 45 days after hospitalization, with the median survivor time of 13·5 days (IQR, 8-17). Interpretation: We drew a clear picture of disease progression in non-survivors. Our data showed biochemical and immune parameters dynamically changed during illness evolution in non-survivors, suggesting the importance of early intervention. Funding Statement: The study was supported by the Key Project for Anti-2019 novel Coronavirus Pneumonia from the Ministry of Science and Technology, China (no. 2020YFC0845500). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This study was conducted according to the principles of Helsinki and approved by the Ethics Committee of Zhongnan Hospital of Wuhan University (No.2020063). Due to the urgent need for this emerging epidemic, the requirements for informed consent from patients were waived.