








key: cord-010536-9ea7vvsz
authors: Chu, Yanan; Li, Tong; Fang, Qiang; Wang, Xingxiang
title: Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): A multi-center study in Wenzhou city, Zhejiang, China
date: 2020-04-28
journal: J Infect
DOI: 10.1016/j.jinf.2020.03.023
sha: 
doc_id: 10536
cord_uid: 9ea7vvsz

nan

We read with great interest the article by Wenjie Yang and colleagues1, accepted for publication in the Journal of Infection. The authors performed a retrospective multi-center cohort study and presented important data regarding the observation that most patients of 2019 novel coronavirus disease (COVID-19) from Wenzhou city, Zhejiang, exhibited mild infection. However, the information of critically ill patients, especially with ICU care and extracorporeal membrane oxygenation (ECMO) treatment, were scare. No study to date has provided evidence that the clinical features of critically ill patients with confirmed COVID-19 from Zhejiang province. We performed a single-centered, retrospective, observational study to investigate the clinical characteristics and ventilation conditions of critically ill patients infected with SARS-CoV-2. From late January, 2020, to February 23, 2020, 33 critically ill patients in the ICU of the First Affiliated Hospital of Zhejiang University who were diagnosed as COVID-19 in accordance with the diagnosis and treatment guidance published by the Chinese government were enrolled in the study2. We obtained patients demographics, epidemiology data, and details of laboratory tests, treatments, and ECMO implantation. The baseline epidemiological characteristics and clinical features of 33 studied patients as classified by with or without ECMO treatment, were shown in Table  1 . Most of the patients admitted to the ICU were older and had several common comorbid conditions, which demonstrated that age and comorbidities might be the indicators for severely ill one and poor prognosis. Of all patients, the mean age was 65.2±16.6 years, and most of the patients were aged 65 years and older. Of the seven patients who received ECMO, the mean age was 67.0±17.7 years. observed man probably had more complicated clinical conditions and worse inhospital outcomes as compared to women in severe COVID-19 patients. The median time from onset of symptoms to hospital admission was 10 days (IQR 5-13 days) which was longer than Wenjie Yang and colleagues' study. In terms of baseline laboratory data of severely confirmed COVID-19 patients, three (9%) and 22 (66.7%) of 33 patients exhibited leucopenia and lymphopenia, respectively. Platelets levels on admission were lower in patients with ECMO treatment than non-ECMO patients. Also, a recent case report verified the counts of peripheral CD4 and CD8 T cells were both decreased in a 50-year-old man with SARS-CoV-2 infection through the technology of flow cytometric analysis4. Specifically, the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) on admission were higher in ECMO treated patients (median AST 38. Table 1 ). Besides, admission levels of total bilirubin were increased substantially in ECMO treated patients. These abnormalities suggested that SARS-CoV-2 might be related to hepatic injury. However, almost all of the included patients received antivirus treatment, the drug induced liver injury could not be excluded. Huang et al. reported that increased level of AST was found in about 62% of the ICU patients in their study5. Therefore, damaged liver function is more common in serious COVID-19 patients. Up to now, there was no sufficient evidence to clarify SARS-CoV-2 as the main reason of damaged liver function. Further studies should concentrate on the reasons of liver function damage in patients with COVID-19. The level of procalcitonin increased in more than 70% of included patients, and most of patients in our study received antibacterial and antifungal agents. One possible explanation for the results may be that many of the critically ill patients were associated with combined infection of bacterial or fungal before the commencement of ECMO. ECMO has been increasingly being used as a rescue treatment for refractory hypoxemia in patients with severe acute respiratory distress syndrome6. The initial mode was veno-venous (VV) ECMO in the 7 patients. Initiation of ECMO was accompanied by a significant improvement in PaO2/FiO2 ratio, and a significant decreases in PaCO2, FiO2 (Table 2 ). Research showed too high level of FiO2 was related to increased production of reactive oxygen-derived free radicals which are noxious to the humans health7. In summary, our data indicate that SARS-CoV-2 infection might cause damage to the immune and liver function of COVID-19 patients. ECMO support was associated with improved ventilation conditions in COVID-19 patients with refractory hypoxemia. The study may be helpful to providing evidence of the appropriate time to initiate ECMO for critically ill patients with COVID-19, and add further evidence for critically ill patients characteristics by Wenjie Yang et al.

Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city

National Administration of Traditional Chinese Medicine. Guidelines for the diagnosis and treatment of novel coronavirus pneumonia (trial version sixth)

Pathological findings of COVID-19 associated with acute respiratory distress syndrome

Clinical features of patients infected with

Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial

Bench-to-bedside review: the effects of hyperoxia during critical illness

The authors would like to thank all participants of the study , the nurses and clinical staff who are providing care for the patients, and thanked for the guidance and help from HDH, WYK.

This work was supported by the Department of Science and Technology of Zhejiang province.

The authors of this study declared no conflict of interest.

