Clinical Characteristics of Deceased Patients Infected with SARS-CoV-2 in Wuhan, China

Background: The 2019 novel coronavirus-infected disease (COVID-19) breakout in Wuhan of China has caused growing concerns about the consequences. Here we report the worst consequence, death cases with COVID-19, aiming to find out the main causes and risk factors. <br><br>Methods: Retrospective, single-center case series of two groups, 65 deceased patients (i.e., those not to survive, leading to death cases) and 96 surviving patients, all were confirmed with COVID-19 at Wuhan Red Cross Hospital in Wuhan from January 21st to February 14th, 2020. Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. <br><br>Findings: Among 65 deceased patients, 52 (80%) of them were over 60 years old and males accounted for the majority (42 [65%]). Their most common coexisting health issues were cardiovascular (36 [60%]) and endocrine system (22 [43%]) diseases. Common symptoms at onset of their illnesses were short of breathe (65 [100%]), fever (59 [91%]), fatigue 56 [86%]), anorexia (54 [86%]) and cough (42 [65%]). By contrast, 31% of the 96 surviving patients had leukopenia, comparing toonly 8% of the deceased. The deceased patients’ average percentage of lymphocytes was higher than the surviving group’s at the time of symptoms onset (P&lt;0.0001). The average levels of urea nitrogen, creatinine, CK and LDH were all higher in the deceased patients than the survivors ( P&lt;0.0001 ). Infection-related biomarkers including CRP also showed a significant difference between the deceased group and the surviving group (P&lt;0.0001). CT images showed a tendency that more deceased patients had bronchitis, bilateral pneumonia with multiple motting and ground-glass opacitylesions in the lung than those to survive ( P &lt;0.0001 ). Comorbidities among the 65 patients not to survive included acute respiratory injury (31 [48%]), ARDS (27 [42%]), acute heart injury (3 [5%]), acute renal injury (2 [3%]) and septic shock (1 [2%]), comparing to one (1%) survivor with ARDS ( P&lt;0.0001 ). <br><br>Interpretation: The main causes of death were acute respiratory injury and ARDS. Risk factors were ages and underlying diseases. The full spectrum of disease severity (range from asymptomatic, to symptomatic extents, requiring hospitalization or fatal), treatment and prevention require further investigations.<br><br>Funding Statement: This work was supported by grants 2016YFC1306600 (to NX) and 2018YFC1314700 (to NX) from the National Key R&amp;D Program of China, grants 81873782 (to NX) National Natural Science Foundation, 2016CFB624 from Natural Science Foundation of Hubei Province (to NX), Grant 2017050304010278 from The Youth Science and technology morning light program of Wuhan City (to NX), 2018 Hubei medical research project WJ2019F030 (to NX), 2018 Wuhan medical research project S201802140011 (to NX), 2018 Wuhan Young and Middle-aged medical Talents Program (to NX) and 2017 Hubei provincial Party Committee Organization Department the second batch of Hubei youth elite development plan (to NX).<br><br>Declaration of Interests: The authors stated: "None to declare."<br><br>Ethics Approval Statement: The study was approved by WRCH Ethics Committee and written informed consent was obtained from patients involved before enrolment when data were collected retrospectively.