JZUS - Journal of Zhejiang University SCIENCE

Journal of Zhejiang University SCIENCE B

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Clinical characteristics of 34 COVID-19 patients admitted to intensive care unit in Hangzhou, China

Author(s): Yi Zheng, Li-jun Sun, Mi Xu, Jian Pan, Yun-tao Zhang, Xue-ling Fang, Qiang Fang, Hong-liu Cai
Affiliation(s): Department of Critical Care Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; more
Corresponding email(s): 1193001@zju.edu.cn
Key Words: Coronavirus disease 2019 (COVID-19); Clinical characteristics; Intensive care unit (ICU); Mechanical ventilation

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Abstract: Objective: This study summarizes and compares clinical and laboratory characteristics of 34 patients admitted to the intensive care unit (ICU) for complications from coronavirus disease 2019 (COVID-19) at the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China from Jan. 22 to Mar. 5, 2020. Methods: A total of 34 patients were divided into two groups, including those who required noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) with additional extracorporeal membrane oxygenation (ECMO) in 11 patients. Clinical features of COVID-19 patients were described and the parameters of clinical characteristics between the two groups were compared. Results: The rates of the acute cardiac and kidney complications were higher in IMV cases than those in NIV cases. Most patients had lymphocytopenia on admission, with lymphocyte levels dropping progressively on the following days, and the more severe lymphopenia developed in the IMV group. In both groups, T lymphocyte counts were below typical lower limit norms compared to B lymphocytes. On admission, both groups had higher than expected amounts of plasma interleukin-6 (IL-6), which over time declined more in NIV patients. The prothrombin time was increased and the levels of platelet, hemoglobin, blood urea nitrogen (BUN), D-dimer, lactate dehydrogenase (LDH), and IL-6 were higher in IMV cases compared with NIV cases during hospitalization. Conclusions: Data showed that the rates of complications, dynamics of lymphocytopenia, and changes in levels of platelet, hemoglobin, BUN, D-dimer, LDH and IL-6, and prothrombin time in these ICU patients were significantly different between IMV and NIV cases.

中国杭州市重症监护室34例COVID-19患者临床特点的分析

目的:本研究拟总结2020年1月22日至3月5日在中国杭州浙江大学医学院附属第一医院重症监护病房(ICU)收治的34例2019冠状病毒病(COVID-19)患者的临床和实验室特征.
创新点:本研究比较了COVID-19患者有创机械通气组(IMV)与无创氧疗组(NIV)的临床和化验室特征,并探讨了两组患者间化验室指标的动态变化的差异.
方法:纳入研究期间入住我院ICU的新冠肺炎重症患者,收集所有患者临床资料和化验室资料.根据是否接受有创机械通气将患者分为IMV组和NIV组.比较两组的临床特征参数,并动态观察两组化验室指标的变化.
结论:NIV组患者急性肝、心、肾并发症发生率较高.两组患者在入院时均出现淋巴细胞减少,但随着病情进展IMV组出现更严重的淋巴细胞减少症.与B淋巴细胞相比,两组T淋巴细胞计数均更明显低于正常值下限.入院时,两组患者的血浆白介素-6(IL-6)水平均高于正常值上限.随着时间的推移,NIV组患者的IL-6水平下降更多.住院期间IMV组患者的血小板、血红蛋白、血尿素氮、凝血酶原时间、D-二聚体、乳酸脱氢酶和IL-6水平均高于NIV患者.
关键词组：2019 冠状病毒病(COVID-19);临床特征;重症监护室(ICU);机械通气

Reference

[1]Arihan O, Wernly B, Lichtenauer M, et al., 2018. Blood urea nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU. PLoS ONE, 13(1):e0191697.

[2]Brodie D, Bacchetta M, 2011. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med, 365(20):1905-1914.

[3]Cheng YD, Zhao H, Song PX, et al., 2019. Dynamic changes of lymphocyte counts in adult patients with severe pandemic H1N1 influenza A. J Infect Public Health, 12(6):878-883.

[4]Chu H, Zhou J, Wong BHY, et al., 2016. Middle East respiratory syndrome coronavirus efficiently infects human primary T lymphocytes and activates the extrinsic and intrinsic apoptosis pathways. J Infect Dis, 213(6):904-914.

[5]Cui W, Fan Y, Wu W, et al., 2003. Expression of lymphocytes and lymphocyte subsets in patients with severe acute respiratory syndrome. Clin Infect Dis, 37(6):857-859.

[6]Ferrer P, Amelio J, Ballarin E, et al., 2016. Systematic review and meta-analysis: macrolides- and amoxicillin/clavulanate-induced acute liver injury. Basic Clin Pharmacol Toxicol, 119(1):3-9.

[7]Gacouin A, Jouneau S, Letheulle J, et al., 2015. Trends in prevalence and prognosis in subjects with acute chronic respiratory failure treated with noninvasive and/or invasive ventilation. Respir Care, 60(2):210-218.

[8]Gu J, Gong EC, Zhang B, et al., 2005. Multiple organ infection and the pathogenesis of SARS. J Exp Med, 202(3):415-424.

[9]He ZP, Zhao CH, Dong QM, et al., 2005. Effects of severe acute respiratory syndrome (SARS) coronavirus infection on peripheral blood lymphocytes and their subsets. Int J Infect Dis, 9(6):323-330.

[10]Huang CL, Wang YM, Li XW, et al., 2020. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 395(10223):497-506.

[11]Kalil AC, Florescu DF, 2009. Prevalence and mortality associated with cytomegalovirus infection in nonimmunosuppressed patients in the intensive care unit. Crit Care Med, 37(8):2350-2358.

[12]Khwaja A, 2012. Kdigo clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 120(4):c179-c184.

[13]Libert N, Bigaillon C, Chargari C, et al., 2015. Epstein-Barr virus reactivation in critically ill immunocompetent patients. Biomed J, 38(1):70-76.

[14]Limaye AP, Kirby KA, Rubenfeld GD, et al., 2008. Cytomegalovirus reactivation in critically ill immunocompetent patients. JAMA, 300(4):413-422.

[15]Lindenauer PK, Stefan MS, Shieh MS, et al., 2014. Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease. JAMA Intern Med, 174(12):1982-1993.

[16]Liu WJ, Zhao M, Liu KF, et al., 2017. T-cell immunity of SARS-CoV: implications for vaccine development against MERS-CoV. Antiviral Res, 137:82-92.

[17]Mahallawi WH, Khabour OF, Zhang QB, et al., 2018. MERS-CoV infection in humans is associated with a pro-inflammatory Th1 and Th17 cytokine profile. Cytokine, 104:8-13.

[18]NHC (National Health Commission of the People’s Republic of China), 2020a. Diagnosis and treatment of COVID-19 (Version 6). http://www.nhc.gov.cn/xcs/zhengcwj/202002/8334a8326dd94d329df351d7da8aefc2/files/b218cfeb1bc54639af227f922bf6b817.pdf [Accessed on Feb. 18, 2020] (in Chinese).

[19]NHC, 2020b. Notification of 2020-NCOV infection. http://www.nhc.gov.cn/xcs/yqtb/202005/11f6b5e28be64f28b5b84eed2984ed60.shtml [Accessed on Apr. 30, 2020] (in Chinese).

[20]Ranieri VM, Rubenfeld GD, Thompson T, et al., 2012. Acute respiratory distress syndrome: the Berlin definition. JAMA, 307(23):2526-2533.

[21]WHO (World Health Organization), 2019. Middle East respiratory syndrome coronavirus (MERS-CoV). http://www. who.int/emergencies/mers-cov/en [Accessed on Mar. 5, 2020].

[22]WHO, 2020. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. https:// www.who.int/csr/sars/country/table2004_04_21/en [Accessed on Jan. 19, 2020].

[23]Wong CK, Lam CWK, Wu AKL, et al., 2004. Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol, 136(1):95-103.

[24]Wong RSM, Wu A, To KF, et al., 2003. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. BMJ, 326(7403):1358-1362.

[25]Yang XB, Yu Y, Xu JQ, et al., 2020. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med, 8(5):475-481.

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中国杭州市重症监护室34例COVID-19患者临床特点的分析

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