Clinical Characteristics of Patients Who Died of Coronavirus Disease 2019 in China

This case series describes the characteristics of a cohort of patients who died of coronavirus disease 2019 in China.


Introduction
The outbreak of coronavirus disease 2019 (COVID-19) has been very severe in China. 1 As of March 2020, many tens of thousands of patients have had confirmed COVID-19, and cases have been increasing daily. 2 The mortality is much higher in Wuhan, China, than in other cities. 3 To understand the characteristics of patients who die of COVID-19, we analyzed 168 patients with COVID-19induced pneumonia who died.

Methods
This case series' study protocol was approved by each local institutional ethics committees.Written informed consent was waived owing to the urgent need to collect data.Data were obtained from 21 hospitals in Wuhan, China.Demographic, comorbidity, and respiratory support data for 168 patients who died of COVID-19 between January 21 to 30, 2020, in these hospitals were collected.All patients were diagnosed as having COVID-19 according to World Health Organization guidance. 3All patients underwent nucleic acid testing by reverse transcription-polymerase chain reaction testing, and their results were positive for COVID-19.Categorical variables were described as numbers (proportions) and continuous variables were described as medians and interquartile ranges (IQRs).Data were analyzed from February 8 to February 10, 2020.

Results
Of 168 patients who died, 126 (75.0%) were men.The median (IQR) age was 70 (64-78) years, and 161 patients (95.8%) were older than 50 years.The age distribution of men and women patients is

Discussion
The results of this case series show that only approximately one-fifth of patients who died of COVID-19 received invasive mechanical ventilation and further aggressive respiratory support prior to death, indicating that many patients had delayed intubation.A 2015 study showed that delayed intubation after the failure of high-flow nasal oxygen or noninvasive ventilation for patients with moderate and severe respiratory failure was associated with increased mortality. 4Additionally, approximately 27% of patients only received nasal or face mask oxygen treatment before they died.Several reasons may explain this low proportion.First, some patients with severe hypoxemia did not have other symptoms, such as shortness of breath or dyspnea, also called silent hypoxemia.Second, the lack of enough invasive mechanical ventilators is an important reason that would prevent patients from receiving intubation.Third, a medical team that is not dominated by intensivists may not receive critical care training; therefore, they may be uncertain on the timing for when a patient requires intubation.

Figure
Figure.Characteristics of Patients Who Died of Coronavirus Disease 2019