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      Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China

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          Abstract

          Dear Editor, The rapid emergence of COVID-19 in Wuhan city, Hubei Province, China, has resulted in thousands of deaths [1]. Many infected patients, however, presented mild flu-like symptoms and quickly recover [2]. To effectively prioritize resources for patients with the highest risk, we identified clinical predictors of mild and severe patient outcomes. Using the database of Jin Yin-tan Hospital and Tongji Hospital, we conducted a retrospective multicenter study of 68 death cases (68/150, 45%) and 82 discharged cases (82/150, 55%) with laboratory-confirmed infection of SARS-CoV-2. Patients met the discharge criteria if they had no fever for at least 3 days, significantly improved respiratory function, and had negative SARS-CoV-2 laboratory test results twice in succession. Case data included demographics, clinical characteristics, laboratory results, treatment options and outcomes. For statistical analysis, we represented continuous measurements as means (SDs) or as medians (IQRs) which compared with Student’s t test or the Mann–Whitney–Wilcoxon test. Categorical variables were expressed as numbers (%) and compared by the χ 2 test or Fisher’s exact test. The distribution of the enrolled patients’ age is shown in Fig. 1a. There was a significant difference in age between the death group and the discharge group (p < 0.001) but no difference in the sex ratio (p = 0.43). A total of 63% (43/68) of patients in the death group and 41% (34/82) in the discharge group had underlying diseases (p = 0.0069). It should be noted that patients with cardiovascular diseases have a significantly increased risk of death when they are infected with SARS-CoV-2 (p < 0.001). A total of 16% (11/68) of the patients in the death group had secondary infections, and 1% (1/82) of the patients in the discharge group had secondary infections (p = 0.0018). Laboratory results showed that there were significant differences in white blood cell counts, absolute values of lymphocytes, platelets, albumin, total bilirubin, blood urea nitrogen, blood creatinine, myoglobin, cardiac troponin, C-reactive protein (CRP) and interleukin-6 (IL-6) between the two groups (Fig. 1b and Supplementary Table 1). Fig. 1 a Age distribution of patients with confirmed COVID-19; b key laboratory parameters for the outcomes of patients with confirmed COVID-19; c interval from onset of symptom to death of patients with confirmed COVID-19; d summary of the cause of death of 68 died patients with confirmed COVID-19 The survival times of the enrolled patients in the death group were analyzed. The distribution of survival time from disease onset to death showed two peaks, with the first one at approximately 14 days (22 cases) and the second one at approximately 22 days (17 cases) (Fig. 1c). An analysis of the cause of death was performed. Among the 68 fatal cases, 36 patients (53%) died of respiratory failure, five patients (7%) with myocardial damage died of circulatory failure, 22 patients (33%) died of both, and five remaining died of an unknown cause (Fig. 1d). Based on the analysis of the clinical data, we confirmed that some patients died of fulminant myocarditis. In this study, we first reported that the infection of SARS-CoV-2 may cause fulminant myocarditis. Given that fulminant myocarditis is characterized by a rapid progress and a severe state of illness [3], our results should alert physicians to pay attention not only to the symptoms of respiratory dysfunction but also the symptoms of cardiac injury. Further, large-scale studies and the studies on autopsy are needed to confirm our analysis. In conclusion, predictors of a fatal outcome in COVID-19 cases included age, the presence of underlying diseases, the presence of secondary infection and elevated inflammatory indicators in the blood. The results obtained from this study also suggest that COVID-19 mortality might be due to virus-activated “cytokine storm syndrome” or fulminant myocarditis. Electronic supplementary material Below is the link to the electronic supplementary material. Supplementary material 1 (DOCX 38 kb)

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          Chinese society of cardiology expert consensus statement on the diagnosis and treatment of adult fulminant myocarditis

          Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock, with mortality rates as high as 50%–70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Here, we provide the first expert consensus, the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis, based on data from our recent clinical trial (NCT03268642). In this statement, we describe the clinical features and diagnostic criteria of fulminant myocarditis, and importantly, for the first time, we describe a new treatment regimen termed life support-based comprehensive treatment regimen. The core content of this treatment regimen includes (i) mechanical life support (applications of mechanical respirators and circulatory support systems, including intraaortic balloon pump and extracorporeal membrane oxygenation, (ii) immunological modulation by using sufficient doses of glucocorticoid, immunoglobulin and (iii) antiviral reagents using neuraminidase inhibitor. The proper application of this treatment regimen may and has helped to save the lives of many patients with fulminant myocarditis.
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            Author and article information

            Contributors
            songsingsjx@sina.com
            Journal
            Intensive Care Med
            Intensive Care Med
            Intensive Care Medicine
            Springer Berlin Heidelberg (Berlin/Heidelberg )
            0342-4642
            1432-1238
            3 March 2020
            : 1-3
            Affiliations
            [1 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Institute of Pathology, Tongji Hospital, Tongji Medical College, , Huazhong University of Science and Technology, ; 1095 Jiefang Avenue, Wuhan, 430030 Hubei China
            [2 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Department of Pathology, School of Basic Medicine, Tongji Medical College, , Huazhong University of Science and Technology, ; 1095 Jiefang Avenue, Wuhan, 430030 Hubei China
            [3 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Department of Dermatology, Tongji Hospital, Tongji Medical College, , Huazhong University of Science and Technology, ; 1095 Jiefang Avenue, Wuhan, 430030 Hubei China
            [4 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, , Huazhong University of Science and Technology, ; 1095 Jiefang Avenue, Wuhan, 430030 Hubei China
            [5 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Department of Clinical Immunology, Tongji Hospital, Tongji Medical College, , Huazhong University of Science and Technology, ; 1095 Jiefang Avenue, Wuhan, 430030 Hubei China
            Article
            5991
            10.1007/s00134-020-05991-x
            7080116
            32125452
            © Springer-Verlag GmbH Germany, part of Springer Nature 2020

            This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

            Funding
            Funded by: FundRef http://dx.doi.org/10.13039/501100010909, Young Scientists Fund;
            Award ID: 81703174
            Award ID: 81602722
            Award Recipient :
            Categories
            Letter

            Emergency medicine & Trauma

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