First new coronary critically ill patient characteristics study released
News SIFIC Infection Evidence-Based Information 2/26
Journalist Zhang Wei
Understanding the clinical characteristics of critically ill patients is critical to reducing mortality from new coronavirus pneumonia. On February 24, local time, Tongji Medical College of Huazhong University of Science and Technology, Wuhan Jinyintan Hospital, Wuhan University People's Hospital and other institutions published a retrospective study of 52 critically ill patients in The Lancet Respiratory Medicine. Studies have shown that older patients older than 65 years of age with underlying diseases and acute respiratory distress syndrome have a higher risk of death.
Of the 52 critically ill patients involved in the study, 32 (61.5%) died within 28 days of being admitted to the Intensive Care Unit (ICU). The average time between admission to ICU and death of a patient is 7 days. The study also noted that patients with a history of cerebrovascular disease are at higher risk of death if they are infected with the new coronavirus.
The above study is entitled "Clinical courses and results of criticalpatient patients with new coronavirus pneumonia in Wuhan, China: a single-center retrospective observation study" (Clinical course and outcomes of the critical patients with SARS-CoV-2 in Wuhan, China: a single pneumonia center, retrospective, lallal study). The responsible author is Shang Yu, deputy director of the Department of Critical Medicine of Concord Hospital, affiliated with Tongji Medical College of Huazhong University of Science and Technology. The authors also include Shu Huaqing, Liu Hong, Shao Xiaojing, Yuan Shiguang and Yu Xiang, deputy director of the Critical Medicine Department of Tongji Medical College of Huazhong University of Science and Technology.
The study was completed at Wuhan Jinyintan Hospital, where all patients were transferred from other hospitals, with the exception of the medical staff infected in the hospital. In terim guidelines from the World Health Organization, the researchers conducted a retrospective analysis of patients diagnosed with new coronary pneumonia and critical condition between 24 December 2019 and 26 January 2020.
Critically ill patients are defined as patients who are admitted to an intensive care unit (ICU) and require more than 60% of oxygen concentration scores (FiO2) in mechanical ventilation or inhaled gas.
The researchers analyzed clinical electronic medical records, nursing records, laboratory test results, radiology tests, and admission data for all laboratory-confirmed patients with new coronavirus infection swashes during this period. The researchers reconfirmed the patient's survival status on February 9, 2020.
Figure 1: Study flowchart
Most critically ill patients have impaired organ function
The paper shows that as of January 26, 2020, a total of 710 confirmed cases of coronavirus pneumonia were admitted to Jinyin Tan Hospital in Wuhan, 658 cases (93%) were considered to not meet the requirements of the study, and 3 patients had a cardiac arrest immediately after admission. Eventually, 52 (7%) of critically ill patients were included in the study.
Fifty-two critically ill patients are all residents of Wuhan City, transferred from other hospitals to Jinyintan Hospital. The average age was 59.7 years, 27 (52 per cent) were older than 60 years and 35 (67 per cent) were male patients. Seventeen patients (33%) had been exposed to the South China seafood market, and 10 (19%) had been exposed to confirmed or highly suspected new coronavirus infection patients. Twenty-one patients had chronic diseases (40%), of which 7 (13.5%) of cerebrovascular diseases died within 28 days. All patients' chest x-wire tablets were seen on both sides.
Figure 2: Characteristics of patients with severe new coronary pneumonia, including age, sex, history of exposure, chronic diseases, etc.
The most common symptoms of these patients were fever (98%), cough (77%) and breathing difficulties (63.5%). Six of these patients (11%) developed fever 2 to 8 days after developing symptoms associated with neo-coronavirus infection. The median time from the onset of symptoms to the diagnosis of radiology to pneumonia is 5 days. The median time from the onbuticity of symptoms to the arrival of the ICU is 9.5 days.
Most patients had organ function impairment, including 35 cases of acute respiratory distress syndrome (67%), 15 cases of acute kidney injury (29%), 12 cases of heart injury (23%), 15 cases of liver insufficiency (29%) and 1 case of gas chest (2%). Hospital-acquired infections were present in 7 patients (13.5%).
Figure 3: Symptoms, underlying diseases and treatment in patients with severe new coronary pneumonia
61.5% of critically ill patients die within 28 days of admission to ICU
Thirty-three (63.5%) patients received high-flow nasal catheterization, 37 (71%) received mechanical ventilation, 6 (11.5%) underwent lying-down ventilation, 6 (11.5%) applied ECMO (in vitro pulmonary oxygenated) technology, 9 (17%) were treated with kidney replacement and 18 (35%) were treated with vascular constriction. Twenty-three (44%) of patients received antiviral therapy, 49 (94%) received antibiotics and 30 (58%) received glucocorticoid therapy. Eighteen (35 per cent) patients received oseltamivir treatment, 14 (27 per cent) received more cylovir and 7 (13.5 per cent) received lopinavir.
Figure 4: Survival rates in critically ill patients with new coronavirus pneumonia
Of the 52 critically ill patients, 32 (61.5%) died within 28 days of check-in with icU, with the median time from icU to death of 7 days. Patients who die are more likely to develop acute respiratory distress syndrome and receive mechanical ventilation during life than those who survive. Thirty-seven patients (81%) who received mechanical ventilation died within 28 days.
The average age of the patient skilled was greater than that of the surviving patient (64.6 years compared to 51.9 years) and the average age of the patient was more likely to have a chronic disease at the same time (53 percent vs. 20 percent).
Of the 20 surviving patients, 8 have been discharged from the hospital. Three patients were still having invasive ventilation at 28 days and one patient was on ECMO. 1 cases using non-invasive ventilation, 2 cases using high-flow nasal catheter, 6 cases using ordinary nasal catheter.
It is pointed out in the discussion session that this is the first study to describe the characteristics of critically ill patients with new coronavirus pneumonia. In three previously published studies of patients with severe illness, the number of patients was too small to summarize patient characteristics and mortality.
The authors say the pathological basis for viral severe pneumonia is acute respiratory distress syndrome (ARDS), while men and the elderly (over 65 years of age) are more likely to experience ARDS than women or young adults. Therefore, the 28-day mortality rate of patients with severe pneumonia is reasonable. They believe that the mortality rate of patients with critical condition of new coronary pneumonia is expected to decrease as clinical capacity improves.
In addition, the authors stress that fever is the most common symptom in patients with neo-coronavirus pneumonia, but not all patients have fever. In the study, six patients did not develop fever (11.5%) at the time of onset and did not show symptoms of fever after 2 to 8 days. Delays in the symptoms of fever hinder early identification of patients with the new coronavirus infection.
The paper concludes that the mortality rate of patients with critical condition symtitwith with the new coronavirus pneumonia is high.
Older patients older than 65 years of age with underlying diseases and acute respiratory distress syndrome have an increased risk of death.
This article is reproduced from Newsbeat
First new coronary critically ill patient characteristics study released
News SIFIC Infection Evidence-Based Information 2/26
Journalist Zhang Wei
Understanding the clinical characteristics of critically ill patients is critical to reducing mortality from new coronavirus pneumonia. On February 24, local time, Tongji Medical College of Huazhong University of Science and Technology, Wuhan Jinyintan Hospital, Wuhan University People's Hospital and other institutions published a retrospective study of 52 critically ill patients in The Lancet Respiratory Medicine. Studies have shown that older patients older than 65 years of age with underlying diseases and acute respiratory distress syndrome have a higher risk of death.
Of the 52 critically ill patients involved in the study, 32 (61.5%) died within 28 days of being admitted to the Intensive Care Unit (ICU). The average time between admission to ICU and death of a patient is 7 days. The study also noted that patients with a history of cerebrovascular disease are at higher risk of death if they are infected with the new coronavirus.
The above study is entitled "Clinical courses and results of criticalpatient patients with new coronavirus pneumonia in Wuhan, China: a single-center retrospective observation study" (Clinical course and outcomes of the critical patients with SARS-CoV-2 in Wuhan, China: a single pneumonia center, retrospective, lallal study). The responsible author is Shang Yu, deputy director of the Department of Critical Medicine of Concord Hospital, affiliated with Tongji Medical College of Huazhong University of Science and Technology. The authors also include Shu Huaqing, Liu Hong, Shao Xiaojing, Yuan Shiguang and Yu Xiang, deputy director of the Critical Medicine Department of Tongji Medical College of Huazhong University of Science and Technology.
The study was completed at Wuhan Jinyintan Hospital, where all patients were transferred from other hospitals, with the exception of the medical staff infected in the hospital. In terim guidelines from the World Health Organization, the researchers conducted a retrospective analysis of patients diagnosed with new coronary pneumonia and critical condition between 24 December 2019 and 26 January 2020.
Critically ill patients are defined as patients who are admitted to an intensive care unit (ICU) and require more than 60% of oxygen concentration scores (FiO2) in mechanical ventilation or inhaled gas.
The researchers analyzed clinical electronic medical records, nursing records, laboratory test results, radiology tests, and admission data for all laboratory-confirmed patients with new coronavirus infection swashes during this period. The researchers reconfirmed the patient's survival status on February 9, 2020.
Figure 1: Study flowchart
Most critically ill patients have impaired organ function
The paper shows that as of January 26, 2020, a total of 710 confirmed cases of coronavirus pneumonia were admitted to Jinyin Tan Hospital in Wuhan, 658 cases (93%) were considered to not meet the requirements of the study, and 3 patients had a cardiac arrest immediately after admission. Eventually, 52 (7%) of critically ill patients were included in the study.
Fifty-two critically ill patients are all residents of Wuhan City, transferred from other hospitals to Jinyintan Hospital. The average age was 59.7 years, 27 (52 per cent) were older than 60 years and 35 (67 per cent) were male patients. Seventeen patients (33%) had been exposed to the South China seafood market, and 10 (19%) had been exposed to confirmed or highly suspected new coronavirus infection patients. Twenty-one patients had chronic diseases (40%), of which 7 (13.5%) of cerebrovascular diseases died within 28 days. All patients' chest x-wire tablets were seen on both sides.
Figure 2: Characteristics of patients with severe new coronary pneumonia, including age, sex, history of exposure, chronic diseases, etc.
The most common symptoms of these patients were fever (98%), cough (77%) and breathing difficulties (63.5%). Six of these patients (11%) developed fever 2 to 8 days after developing symptoms associated with neo-coronavirus infection. The median time from the onset of symptoms to the diagnosis of radiology to pneumonia is 5 days. The median time from the onbuticity of symptoms to the arrival of the ICU is 9.5 days.
Most patients had organ function impairment, including 35 cases of acute respiratory distress syndrome (67%), 15 cases of acute kidney injury (29%), 12 cases of heart injury (23%), 15 cases of liver insufficiency (29%) and 1 case of gas chest (2%). Hospital-acquired infections were present in 7 patients (13.5%).
Figure 3: Symptoms, underlying diseases and treatment in patients with severe new coronary pneumonia
61.5% of critically ill patients die within 28 days of admission to ICU
Thirty-three (63.5%) patients received high-flow nasal catheterization, 37 (71%) received mechanical ventilation, 6 (11.5%) underwent lying-down ventilation, 6 (11.5%) applied ECMO (in vitro pulmonary oxygenated) technology, 9 (17%) were treated with kidney replacement and 18 (35%) were treated with vascular constriction. Twenty-three (44%) of patients received antiviral therapy, 49 (94%) received antibiotics and 30 (58%) received glucocorticoid therapy. Eighteen (35 per cent) patients received oseltamivir treatment, 14 (27 per cent) received more cylovir and 7 (13.5 per cent) received lopinavir.
Figure 4: Survival rates in critically ill patients with new coronavirus pneumonia
Of the 52 critically ill patients, 32 (61.5%) died within 28 days of check-in with icU, with the median time from icU to death of 7 days. Patients who die are more likely to develop acute respiratory distress syndrome and receive mechanical ventilation during life than those who survive. Thirty-seven patients (81%) who received mechanical ventilation died within 28 days.
The average age of the patient skilled was greater than that of the surviving patient (64.6 years compared to 51.9 years) and the average age of the patient was more likely to have a chronic disease at the same time (53 percent vs. 20 percent).
Of the 20 surviving patients, 8 have been discharged from the hospital. Three patients were still having invasive ventilation at 28 days and one patient was on ECMO. 1 cases using non-invasive ventilation, 2 cases using high-flow nasal catheter, 6 cases using ordinary nasal catheter.
It is pointed out in the discussion session that this is the first study to describe the characteristics of critically ill patients with new coronavirus pneumonia. In three previously published studies of patients with severe illness, the number of patients was too small to summarize patient characteristics and mortality.
The authors say the pathological basis for viral severe pneumonia is acute respiratory distress syndrome (ARDS), while men and the elderly (over 65 years of age) are more likely to experience ARDS than women or young adults. Therefore, the 28-day mortality rate of patients with severe pneumonia is reasonable. They believe that the mortality rate of patients with critical condition of new coronary pneumonia is expected to decrease as clinical capacity improves.
In addition, the authors stress that fever is the most common symptom in patients with neo-coronavirus pneumonia, but not all patients have fever. In the study, six patients did not develop fever (11.5%) at the time of onset and did not show symptoms of fever after 2 to 8 days. Delays in the symptoms of fever hinder early identification of patients with the new coronavirus infection.
The paper concludes that the mortality rate of patients with critical condition symtitwith with the new coronavirus pneumonia is high.
Older patients older than 65 years of age with underlying diseases and acute respiratory distress syndrome have an increased risk of death.
This article is reproduced from Newsbeat
IMAGES BELOW !!!! FOR ARTICLE
首份新冠危重患者特征研究发布
澎湃新闻 SIFIC感染循证资讯 2/26
澎湃新闻记者 张唯了解危重症患者的临床特征对于降低新型冠状病毒肺炎的死亡率至关重要。当地时间2月24日，华中科技大学同济医学院、武汉市金银潭医院、武汉大学人民医院等机构在《柳叶刀呼吸医学》(The Lancet Respiratory Medicine)发表了一项针对52名危重症患者的回顾性研究。研究显示，年龄大于65岁且患有基础疾病和急性呼吸窘迫综合征的老年患者有更高的死亡风险。研究涉及的52名危重症患者患者中，32名（61.5%）在入住重症监护室（ICU）后28天内死亡。死亡患者从入住ICU到死亡的平均时间为7天。研究还指出，有脑血管病史的患者若感染新型冠状病毒，会有更高的病危或死亡风险。上述研究题为《中国武汉新型冠状病毒肺炎危重患者的临床病程与结果：一项单中心回顾性观察研究》（Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan,China: a single centered,retrospective,observational study）。责任作者是华中科技大学同济医学院附属协和医院重症医学科副主任尚游。作者还包括华中科技大学同济医学院附属协和医院重症医学科舒化青、刘宏、邹晓静、袁世荧和武汉大学人民医院重症医学科副主任余追等人。研究在武汉金银潭医院完成，除该院感染的医护人员外，所有病人均从其他医院转院而来。根据世界卫生组织的临时指南，研究人员对2019年12月24日至2020年1月26日期间被确诊为新冠肺炎且属于危重症的患者进行了回顾性分析。危重症患者被定义为入住重症监护病房（ICU）且需要机械通气或吸入气中的氧浓度分数（FiO2）超过60%的患者。研究人员分析了这段时间内，院内所有经实验室确诊的新冠病毒感染患者的临床电子病历、护理记录、实验室检查结果、放射学检查和入院数据。研究人员在2020年2月9日重新确认了患者的生存状态。📷图1：研究流程图多数危重症患者出现器官功能受损论文显示，截至2020年1月26日，武汉金银谭医院共收治确诊新型冠状病毒肺炎710例，658例（93%）被认为不符合研究要求，3例患者入院后立即发生心脏骤停。最终有52名（7%）危重症患者被纳入本研究。52名危重症患者均为武汉市居民，从其他医院转院至金银潭医院。平均年龄为59.7岁，27人（52%）大于60岁，男性患者35例（67%）。17例（33%）患者曾接触过华南海鲜市场，10例（19%）患者曾接触过确诊或高度疑似的新型冠状病毒感染病人。21例患者有慢性疾病（40%），其中脑血管疾病7例（13.5%），均在28天内死亡。所有患者胸部x线片均见双侧浸润。📷图2：重症新冠肺炎患者的特征统计，含年龄、性别、暴露史、慢性疾病等上述患者中，最常见的症状是发热（98%）、咳嗽（77%）和呼吸困难（63.5%）。其中6位患者（11%）在出现与新冠病毒感染有关的症状后2至8天才开始发热。从症状出现到放射学确诊为肺炎的中位时间是5天。从症状出现到入住ICU的中位时间为9.5天。多数患者出现器官功能受损，其中急性呼吸窘迫综合征35例（67%），急性肾损伤15例（29%），心脏损伤12例（23%），肝功能不全15例（29%）和气胸1例（2%）。医院获得性感染在7名（13.5%）患者中出现。📷图3：重症新冠肺炎患者的症状、基础疾病及治疗61.5%危重症患者入住ICU后28天内死亡33名（63.5％）患者接受高流量鼻导管治疗，37名（71％）接受机械通气，6名（11.5％）进行了俯卧位通气，6名（11.5％）运用了ECMO(体外膜肺氧合)技术，9名（17％）进行肾脏替代治疗和18名（35％）进行血管收缩治疗。23名（44％）患者接受了抗病毒疗法，49名（94％）患者接受抗生素治疗，30名（58％）患者接受糖皮质激素治疗。18名（35%）患者接受奥司他韦的治疗，14名（27%）接受更昔洛韦治疗，7名（13.5%）患者接受洛匹那韦治疗。📷图4：新型冠状病毒肺炎危重患者的存活率 在52名危重症患者中，32名（61.5%）在入住ICU后28天内死亡，从入住ICU到死亡的中位时间为7天。与生存患者相比，死亡患者生前更容易出现急性呼吸窘迫综合征，更可能接受机械通气。37例（81%）接受机械通气的患者在28天内去世。 与生存患者相比，死亡患者平均年龄更大（64.6岁比51.9岁），更有可能同时患有慢性疾病（53%比20%）。 在20名生存患者中，有8名患者已经出院。三名患者在28天时仍在进行有创通气，一名患者在进行ECMO。1例采用无创通气，2例采用高流量鼻导管，6例采用普通鼻导管。 论文讨论环节指出，这是首份描述新型冠状病毒肺炎危重患者特征的研究。在之前发表的三项针对重症患者的研究中，患者数量太少，无法总结患者特征和死亡率。 论文作者表示，病毒性重症肺炎的病理基础是急性呼吸窘迫综合征（ARDS），而男性和老年人（65岁以上）比女性或年轻人更容易发生ARDS。因此，新冠病毒肺炎危重症患者28天的死亡率接近于严重ARDS的死亡率（50%）是合理的。他们认为，随着临床治疗能力的提高，预计新冠肺炎危重症患者的死亡率将下降。 此外，作者强调，发热是新冠病毒肺炎患者最常见的症状，但并非所有患者都有发热现象。研究中，6名患者在发病时未出现发热（11.5%），在2至8天后才见发热症状。发热症状的延迟阻碍了新型冠状病毒感染患者的早期识别。 论文总结称，新型冠状病毒肺炎危重症患者的死亡率高。 年龄大于65岁且患有基础疾病和急性呼吸窘迫综合征的老年患者死亡风险增加。本文转载自澎湃新闻
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