key: cord-0296210-mlkxcn5k
authors: Liu, Yanli; Sun, Wenwu; Li, Jia; Chen, Liangkai; Wang, Yujun; Zhang, Lijuan; Yu, Li
title: Clinical features and progression of acute respiratory distress syndrome in coronavirus disease 2019
date: 2020-02-20
journal: nan
DOI: 10.1101/2020.02.17.20024166
sha: f0e75c4697317cbd0e3a5cdd722fe0526595db64
doc_id: 296210
cord_uid: mlkxcn5k

Background: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) results in a cluster of coronavirus disease 2019 (COVID-19). We reported the clinical characteristics of COVID-19 patients with acute respiratory distress syndrome (ARDS), and further investigated the treatment and progression of ARDS in COVID-19. Methods: This study enrolled 109 patients with COVID-19 admitted to the Central Hospital of Wuhan, a designated hospital in Wuhan, China, from January 2 to February 1, 2020. Patients were followed up to February 12, 2020. The clinical data were collected from the electronic medical records. The differences in the treatment and progression with the time and the severity of ARDS were determined. Findings: Among 109 patients, mean age was 55 years, and 59 patients were male. With a median 15 days (range, 4 to 30 days) follow-up period, 31 patients (28.4%) died, while 78 (71.6%) survived and discharged. Of all patients, 53 (48.6%) developed ARDS. Compared to non-ARDS patients, ARDS patients were elder (mean age, 61 years vs. 49 years), and more likely to have the coexistent conditions, including diabetes (20.8% vs. 1.8%), cerebrovascular disease (11.3% vs. 0%), and chronic kidney disease (15.1% vs. 3.6%). Compared to mild ARDS patients, those with moderate and severe ARDS had higher mortality rates. No significant effect of antivirus, glucocorticoid, or immunoglobulin treatment on survival was observed in patients with ARDS. Interpretation: The mortality rate increased with the severity of ARDS in COVID-19, and the effects of current therapies on the survival for these patients were not satisfactory, which needs more attention from clinicians. Funding: Health and Family Planning Commission of Wuhan Municipality.

Throat swab samples were collected from the suspected patients, and the method of . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

is the (which was not peer-reviewed) The copyright holder for this preprint . biotechnology Co. Ltd). Positive test results for two target genes were considered as 1 5 8

laboratory-confirmed infection. ARDS groups over time. All statistical analysis were performed by the statistical 1 7 0 software packages R (http://www.R-project.org, The R Foundation) and the 1 7 1 . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

is the (which was not peer-reviewed) The copyright holder for this preprint . The most common symptom at the illness onset was fever (82.6%), followed by dry non-ARDS patients (3.6%). The mortality rate in ARDS patients (49.1%) was also 1 9 6

significantly higher than that in non-ARDS patients (8.9%). 0.06 ng/mL). Significant increased levels of blood urea nitrogen, serum fibrinogen, D- As shown in Figure 1 , the dynamic trajectory in nine laboratory parameters were 2 1 4 tracked on Day 1, 3, 7 and 14, respectively. Significant differences in the levels of 2 1 5 . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

is the (which was not peer-reviewed) The copyright holder for this preprint the levels of other laboratory findings were higher in ARDS patients. According to the severity of ARDS, we further analyzed the clinical features, concomitantly with the severity of ARDS (all P values <0.001). The levels of lactate, ARDS (all log-rank tests P >0.05). Discussion 2 3 6 . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10. 1101 /2020 In the present study of ARDS progression in COVID-19, we firstly identified the To the best of our knowledge, this study is the first to investigate the clinical features 2 4 6 and progression of SARS-CoV-2 infected patients according to the severity of ARDS.

We revealed that elder patients, or complicated by diabetes, cerebrovascular disease, COVID-19 studies 6,7,13 , suggesting that cytokine cascade, excessive inflammatory 2 5 7 . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10. 1101 /2020 reaction, and coagulation dysfunction might evolve in the course of ARDS resulted 2 5 8 from SARS-CoV-2. with ARDS, which might in turn help to guide our medical therapy. The medical management of ARDS has advanced remarkably during the past decades to increased mortality in the front-line epidemic area during the early outbreak period. The epidemic spread knows no borders. We are deeply concerned about the current future, a multi-center and follow-up study with a larger cohort is eagerly warranted. In the current study from one of the designated hospitals in Wuhan, China, the help to guide the risk stratification and therapeutic strategy for COVID-19 patients. . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10.1101/2020.02.17.20024166 doi: medRxiv preprint preparation, review, or approval of the manuscript; and decision to submit the 3 3 8 manuscript for publication. The data that support the findings of this study are available from the corresponding 3 4 2 authors on reasonable request. We can provide participant data without names and 3 4 3

identifiers, but not the study protocol, or statistical analysis plan. After publication of 3 4 4 study findings, the data will be available for others to request. Once the data can be . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

is the (which was not peer-reviewed) The copyright holder for this preprint . https: //doi.org/10.1101 //doi.org/10. /2020 

It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

is the

The copyright holder for this preprint 

White blood cell count, ×10 9 /L 3.5-9.5 5.2 (4.0-7.0) 4.9 (3.8-6.2) 5.4 (4.5-8.0) 0.053 Neutrophil count, ×10 9 /L 1.8-6.3 3.6 (2.8-5.6) 3.2 (2.4-4.2) 4.1 (3.1-7.1) 0.004 Lymphocyte count, ×10 9 /L 1.1-3.2 0.9 (0.5-1.2) 1.0 (0.8-1.4) 0.7 (0.4-1.1) <0.001 C-reactive protein, mg/dL 0-0.5 3. inspired oxygen; IQR, interquartile range; NA, not available; PaO 2 , partial pressure of oxygen; SOFA, Sequential Organ Failure Assessment It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

is the

The copyright holder for this preprint It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

is the

The copyright holder for this preprint . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10. 1101 /2020 

Abbreviations: APACHE II, Acute Physiology and Chronic Health Evaluation II

ARDS, acute respiratory distress syndrome; FiO 2 , fraction of

We deeply regret and mourn all the lives lost in this disaster of SARS-CoV-2, respect to all the people who are currently fighting against the outbreak of COVID-19. report. All authors reviewed and approved the final version.