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Scientists in the report stated the main factors that increase the likelihood of death from the new coronavirus Covid-19.
Physicians analyzed the clinical presentation of 191 adult patients with a confirmed presence of Covid-19 in two hospitals in Wuhan, the epicenter of the new coronavirus in China. Of these patients, 137 were discharged and 54 died in the hospital during the period between December 29, 2019 and January 31, 2020.
Scientists compared clinical records, prescribed treatment, laboratory results and patients’ demographic data.
They studied the clinical course of the disease, its symptoms, the period of viral shedding and changes in laboratory parameters during hospitalization – blood tests, chest X-ray and CT – and used mathematical modeling to assess risk factors.
The results showed that the main risk factors for death that can be identified immediately upon hospital admission are age, signs of sepsis and problems with blood clotting. Other risk factors cited by the researchers are high blood pressure, diabetes and prolonged use of non-invasive lung ventilation.
In addition, the authors provide new data on the period during which treated patients posed a threat to others around them. For recovered patients this period ranged from eight to 37 days, with an average of 20 days. For all 54 deceased patients, the virus remained active until the last day.
The study authors state that the length of this period, and thus the treatment, is primarily influenced by the condition and severity of the disease at the time of hospital admission. It should be emphasized that two-thirds of the patients were hospitalized in serious or critical condition.
„The long period of viral shedding observed in our study has important implications for decisions on preventive measures regarding isolation and antiviral treatment in patients with confirmed Covid-19 infection. (…) However, we must clearly understand that the period of viral shedding should not be confused with the quarantine period during which people who have been exposed to Covid-19 but had no symptoms should be kept. Those depend on the incubation period of the virus,“ said Bin Cao, lead researcher and professor from the China-Japan Friendship Hospital and Capital Medical University in Beijing.
Scientists insist that patients should be discharged from hospitals only after they receive negative tests for Covid-19.
The study first describes a complete picture of the development of Covid-19.
The average duration of fever was about 12 days, but the cough could last much longer.
In 45 percent of surviving patients the cough persisted even after discharge. Shortness of breath in those who recovered disappeared after about 13 days, whereas in those who did not survive it lasted until death. The study also reports the timing of various complications such as sepsis, acute respiratory distress syndrome, acute cardiac injury, acute kidney injury and secondary infections.
The average age of survivors is 52 years and of those who died 69 years. They already had higher scores on the Sequential Organ Failure Assessment at the time of hospital admission, indicating sepsis; increased levels of the protein d-dimer in the blood, which is a sign of coagulation (blood clotting); low leukocyte counts and increased levels of interleukin-6, which is a sign of inflammation and chronic disease; and also increased concentrations of troponin I, a marker of heart attack.
„Poor outcomes in older people may be primarily related to an age-associated weakening of the immune system and increased inflammation, which can contribute to viral replication, and a prolonged inflammatory response that causes lasting damage to the heart, brain and other organs,“ says Zhibo Liu, one of the study’s authors.
