Background
Methods
Study design
The criteria for ICU admission
Data collection and definitions
Family information and visitation policies
Statistical analysis
Results
Demographic and clinical characteristics
Characteristics | All patients (n = 226) |
---|---|
Age, years | 64 (57–70) |
Gender | |
Male | 139 (61.5%) |
Female | 87 (38.5%) |
Occupation | |
Medical worker | 22 (9.7%) |
Unprotected exposure history | 22 (100%) |
Non-medical worker | 204 (90.3%) |
Newly admitted to ICU | 9 (4.0%) |
Duration from the onset of symptom to the current study, days | 31 (24–36) |
Duration from ICU admission to the current study, days | 11 (5–17) |
Comorbidities | 155 (68.6%) |
Hypertension | 96 (42.5%) |
Coronary heart disease | 22 (9.7%) |
Myocardial infarction | 6 (2.7%) |
Congestive heart failure | 4 (1.8%) |
Diabetes | 47 (20.8%) |
Diabetes with organ damage | 10 (4.4%) |
Diabetes without organ damage | 37 (16.4%) |
Cerebrovascular disease | 15 (6.6%) |
Chronic pulmonary disease | 15 (6.6%) |
Chronic hepatopathy | 3 (1.3%) |
Chronic nephrosis (without regular dialysis) | 3 (1.3%) |
Chronic nephrosis (with regular dialysis) | 5 (2.2%) |
Chronic peptic ulcer | 4 (1.8%) |
Connective tissue disease | 1 (0.4%) |
Hemiplegia | 4 (1.8%) |
Alzheimer’s disease | 4 (1.8%) |
Leukemia or lymphoma | 1 (0.4%) |
Malignancy tumor | 10 (4.4%) |
Receive radiotherapy, chemotherapy, and long-term or high-dose corticoid therapy | 1 (0.4%) |
Refusal of endotracheal intubation | 12 (5.3%) |
Declaration of do-not-resuscitate | 11 (4.9%) |
Clinical outcome | |
Remained in ICU | 204 (90.3%) |
Discharged from ICU | 13 (5.7%) |
Died | 9 (4.0%) |
Vital signs, complications, and laboratory tests
Characteristics | All patients (n = 226) |
---|---|
Heart rate (bpm) | 90 (76–103) |
Heart rate > 125 | 9 (4.0%) |
Systolic blood pressure (mmHg) | 125 (110–137) |
Systolic blood pressure < 90 | 2 (0.9%) |
Diastolic blood pressure (mmHg) | 72 (64–80) |
Respiratory rate (breaths per minute) | 22 (20–26) |
Respiratory rate > 24 | 86 (38.1%) |
Saturation of pulse oxygen | 97 (95–99) |
Saturation of pulse oxygen < 90% | 14 (6.2%) |
Temperature (°C) | 36.7 (36.4–37) |
> 37.3 to ≤ 38 | 21 (9.3%) |
> 38 | 24 (10.6%) |
SOFA score (n = 192) | 4 (2–8) |
ARDS | 161 (71.2%) |
Mild ARDS | 35 (15.5%) |
Moderate ARDS | 47 (20.8%) |
Severe ARDS | 79 (35.0%) |
Shock | 36 (15.9%) |
Septic shock | 33 (14.6%) |
Cardiogenic shock | 2 (0.9%) |
Septic combined cardiogenic shock | 1 (0.4%) |
Cardiac injury (hs-TnI > 28 ng/L or TnI > 0.3 ng/mL) | 61 (27.0%) |
Arrhythmia | 21 (9.3%) |
Atrial fibrillation | 18 (8.0%) |
Supraventricular tachycardia | 2 (0.9%) |
Ventricular tachycardia | 1 (0.4%) |
Acute kidney injury by KDIGO criteria | 57 (25.2%) |
Stage 1 | 23 (10.2%) |
Stage 2 | 12 (5.3%) |
Stage 3 | 22 (9.7) |
Hospital-acquired bacterial or fungal infection | 49 (21.7%) |
Duration from the onset of symptom to the current study, days | 33 (27–37) |
Duration from ICU admission to the current study, days | 13 (8–17.5) |
Infectious foci | |
Pulmonary | 45 (19.9%) |
Pulmonary and bloodstream | 2 (0.9%) |
Pulmonary and deep soft tissue | 1 (0.4%) |
Urinary tract | 1 (0.4%) |
Pneumothorax | 1 (0.4%) |
Gastrointestinal hemorrhage | 7 (3.1%) |
Laboratory tests (Table 3)
Characteristics | All patients (n = 226) |
---|---|
Blood routine | |
White blood cell count (×109 per L; normal range 4–10) | 8.54 (5.89–12.69) |
Increased | 95 (42.0%) |
Decreased | 16 (7.1%) |
Hematocrit (%) | 31.1 (26.3–35.7) |
Hemoglobin (g/L; normal range 130–175) | 98 (85–116) |
Decreased | 220 (97.3%) |
Neutrophils (×109 per L; normal range 1.8–6.3) | 7.28 (4.24–10.94) |
Increased | 127 (56.2%) |
Decreased | 4 (1.8%) |
Lymphocytes (×109 per L; normal range 1.1–3.2) | 0.84 (0.56–1.19) |
Increased | 1 (0.4%) |
Decreased | 160 (70.8%) |
Platelets (×109 per L; normal range 125–350) | 181.5 (115–258) |
Increased | 14 (6.2%) |
Decreased | 66 (29.2%) |
Coagulation panel (n = 223) | |
Prothrombin time (s; normal range 11–16) | 13 (11.6–14.7) |
> 16 to ≤ 19 | 19 (8.5%) |
> 19 | 11 (4.9%) |
Activated partial thromboplastin time (s; normal range 28–43.5) | 32.3 (26.1–42.1) |
> 43.5 to ≤ 48.5 | 17 (7.6%) |
> 48.5 | 34 (15.2%) |
D-dimer (n = 212) (mg/L; normal range < 0.5) | 3 (1.2–7.1) |
> 0.5 to ≤ 1 | 20 (9.4%) |
> 1 | 169 (79.7%) |
Hepatic function | |
Glutamic pyruvic transaminase (U/L; normal range < 40) | 31.2 (19–57) |
Increased | 85 (37.6%) |
Glutamic oxalacetic transaminase (U/L; normal range < 50v) | 31.6 (22–48) |
Increased | 46 (20.4%) |
Total bilirubin concentration (μmol/L, normal range 3–22) | 12.6 (8.6–19.1) |
Increased | 42 (18.6%) |
Albumin concentration (g/L, normal range 35–50) | 32.8 (29.4–36.9) |
Decreased | 145 (64.2%) |
Renal function | |
Serum creatinine concentration (μmol/L, normal range 46–92) | 64.2 (49–111.6) |
Increased | 70 (31.0%) |
Blood urea nitrogen (mmol/L, normal range 2.5–6.1) | 7.34 (5.2–14.1) |
Increased | 140 (61.9%) |
Serum electrolyte | |
Potassium (mmol/L, normal range 3.5–5.1) | 4.1 (3.7–4.56) |
Sodium (mmol/L, normal range 135–145) | 140 (137–144) |
Myoglobin plasma concentration (n = 162) (ng/mL, normal range < 150) | |
< 150 | 105 (64.8%) |
≥ 150 to < 1000 | 47 (29.0%) |
≥ 1000 | 10 (6.2%) |
Procalcitonin (n = 220) (ng/mL, normal range < 0.05) | 0.19 (0.05–1.4) |
< 0.05 | 58 (26.4%) |
0.05–0.5 | 80 (36.4%) |
> 0.5 | 82 (37.3%) |
Ferritin concentration (n = 122) (μg/L, normal range < 500) | |
< 500 | 31 (25.4%) |
≥ 500 to < 1000 | 33 (27.1%) |
≥ 1000 to < 1500 | 17 (13.9%) |
≥ 1500 to < 2000 | 10 (8.2%) |
≥ 2000 | 31 (25.4%) |
Managements (Table 4)
Variables | All patients (n = 226) |
---|---|
Respiratory support | |
None | 11 (4.9%) |
Oxygen delivery by nasal cannula | 59 (26.1%) |
Oxygen delivery by mask | 14 (6.2%) |
High-flow nasal cannula (HFNC) | 37 (16.4%) |
Noninvasive mechanical ventilation | 20 (8.8%) |
Invasive mechanical ventilation | 85 (37.6%) |
ECMO | 14 (6.2%) |
Prone position | 22 (9.7%) |
Continuous renal replacement therapy | 24 (10.6%) |
Vasoactive drugs | 48 (21.2%) |
Intravenous antihypertensive drugs | 14 (6.2%) |
Central venous catheterization | 22 (9.7%) |
Thoracic cavity closed drainage | 1 (0.4%) |
Accidental removal of tracheal tube | 2 (0.9%) |
Spontaneous breathing test | 17 (7.5%) |
Spontaneous breathing test (failed) | 15 (6.6%) |
Spontaneous breathing test (passed) | 2 (0.9%) |
Removal of tracheal tube | 1 (0.4%) |
Chest imaging examination | 56 (24.8%) |
Ultrasound examination | 63 (27.9%) |
Chest or lung ultrasound examination | 52 (23.0%) |
Antivirus agent | 117 (51.8%) |
Ribavirin | 35 (15.49%) |
Ganciclovir | 6 (2.65%) |
Interferon inhalation | 9 (3.98%) |
Arbidol | 51 (22.57%) |
Lopinavir-ritonavir | 12 (5.31%) |
Neuaminidase inhibitors | 10 (4.42%) |
Thymosin | 92 (40.7%) |
Antimicrobial agents | 168 (74.3%) |
Systemic glucocorticoids | 37 (16.4%) |
Immunoglobulin | 29 (12.8%) |
Blood transfusion | 19 (8.4%) |
Red blood cell | 11 (4.9%) |
Plasma | 9 (4.0%) |
Blood platelet | 1 (0.4%) |
Traditional Chinese herb | 59 (26.1%) |
Outcomes
Outcome | Age groups (years) | All patients (n = 226) | |||||
---|---|---|---|---|---|---|---|
30–40 (n = 7) | 41–50 (n = 19) | 51–60 (n = 51) | 61–70 (n = 97) | 71–80 (n = 35) | 81–90 (n = 17) | ||
Still hospitalized | 0 (0.0%) | 2 (10.5%) | 4 (7.8%) | 8 (8.3%) | 0 (0.0%) | 1 (5.9%) | 15 (6.7%) |
Discharged | 7 (100.0%) | 8 (42.1%) | 31 (60.8%) | 45 (46.4%) | 23 (65.7%) | 10 (58.8%) | 124 (54.9%) |
Died | 0 (0.0%) | 9 (47.4%) | 16 (31.4%) | 44 (45.4%) | 12 (34.3%) | 6 (35.3%) | 87 (38.5%) |
Died with DNI | 0 (0.0%) | 0 (0.0%) | 1 (2.0%) | 3 (3.1%) | 0 (0.0%) | 3 (17.6%) | 7 (3.1%) |
Patients received IMV | 4 (57.1%) | 15 (78.9%) | 25 (49.0%) | 55 (56.7%) | 18 (51.4%) | 4 (23.5%) | 121 (53.5%) |
Died ever receiving IMV | 0 (0.0%) | 9 (47.4%) | 15 (29.4%) | 40 (41.2%) | 12 (34.2%) | 3 (17.6%) | 79 (35.0%) |
Received NIV before IMV | 3 (42.9%) | 6 (31.6%) | 11 (21.6%) | 29 (29.9%) | 12 (34.3%) | 1 (5.9%) | 62 (27.4%) |