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.
概 要
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。
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Contributions
Hong-liu CAI and Yi ZHENG conceived and designed the study, drafted the paper, and took responsibility for the integrity of the data and the accuracy of the data analysis. Li-jun SUN, Mi XU, and Jian PAN collected the data. Yi ZHENG, Xue-ling FANG, and Yun-tao ZHANG did the analysis. Qiang FANG revised the manuscript. All authors agree to be accountable for all aspects of the work and have read and approved the manuscript.
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Yi ZHENG, Li-jun SUN, Mi XU, Jian PAN, Yun-tao ZHANG, Xue-ling FANG, Qiang FANG, and Hong-liu CAI declare that they have no conflict of interest.
This study was approved by the National Health Commission of China and Ethics Commission of the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China (No. IIT20200077A). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.
Additional information
Project supported by the Project for Emergency of Key R&pD Plan from Zhejiang Science and Technology Agency (No. 2020C03123), China
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Zheng, Y., Sun, Lj., Xu, M. et al. Clinical characteristics of 34 COVID-19 patients admitted to intensive care unit in Hangzhou, China. J. Zhejiang Univ. Sci. B 21, 378–387 (2020). https://doi.org/10.1631/jzus.B2000174
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DOI: https://doi.org/10.1631/jzus.B2000174
Key words
- Coronavirus disease 2019 (COVID-19)
- Clinical characteristics
- Intensive care unit (ICU)
- Mechanical ventilation