Early and critical care in severe patients with COVID-19 infection in Jiangsu Province, China: a descriptive study
Authors: Huang Mao , Yang Yi , Shang Futai , Zheng Yishan , Zhao Wenjing , Luo Liang , Han Xudong , Lin Aihua , Zhao Hongsheng , Gu Qing , Shi Yi , Li Jun , Xu Xingxiang , Liu Kexi , Deng YiJun , Cao Quan , Wang Weiwei 
Published: March 2020

Abstract
Background: Patients with coronavirus disease 2019 (COVID-19) infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which originated in Wuhan, China, and spreading over the country including Jiangsu Province. Our study aimed to study the epidemiological, clinical characteristics and therapies of these severe cases in Jiangsu Province.Methods: A multicenter retrospective cohort study was conducted to extract and analyze epidemiological, clinical, laboratory data and treatment of 60 severe cases with COVID-19 infection from 12 large hospitals in Jiangsu Province between Jan 24 and Feb 23, 2020. Cases were identified by real-time reverse transcription polymerase chain reaction (RT-PCR). The improvement and deterioration subgroups were compared to identify predictors of disease progression. Clinical outcomes were followed up until Feb 23, 2020.Results: A total of 631 infected cases with COVID-19 in Jiangsu Province, 60 of which were severe cases. Up until Feb 23, 2020, the mortality rate of these severe patients was 0%. The median age was 57 years (range, 26 to 97), and 58.3% were man. The body mass index (BMI) of these patients was higher, with an average of 25 kg/m². More than 90 percent of the patients had a history of contact with an infected patient or dined together, and two patients were infected while staying in the same train compartment with a confirmed patient. 51.7% of severe cases had at least one underlying disease, and low fever (80.0%) and dry cough (51.7%) were the most common symptoms. Mean acute physiology and chronic health evaluation (APACHE) II score on admission was 14±5. Acute respiratory distress syndrome (ARDS) appeared in 15% of the patients. White blood cell counts decreased in 45.0% of patients, lymphopenia in 63.3%, thrombocytopenia in 13.3%, and procalcitonin levels in 88.3% of the patients were less than 0.5 ng/mL. There were no statistically significant differences in immunoglobulin therapy and glucocorticoids therapy between the improvement and deterioration subgroups (P>0.05). Logistic regression analysis indentified higher levels of troponin T (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.00-1.08; P=0.04), antiviral therapy with interferon (OR: 6.33; 95% CI: 1.18-33.98; P=0.03), and the application of non-invasive mechanical ventilation (OR: 1.99; 95%CI: 1.17-3.41; P=0.01) as predictors of disease progression, whereas higher lymphocyte count (OR: 0.11; 95% CI: 0.02-0.57; P=0.01) and early prone ventilation were associated with improvement (OR: 0.11; 95% CI: 0.01-0.98; P=0.04).Conclusions: The COVID-19 infection had a low mortality rate in Jiangsu Province, China. The higher levels of troponin T and lower lymphocyte count were predictors of disease progression. Antiviral therapy with interferon was not recommended. The early prone ventilation may be an effective treatment for severe cases.