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Oxford University Press - PMC COVID-19 Collection logoLink to Oxford University Press - PMC COVID-19 Collection
. 2020 Mar 16:ciaa270. doi: 10.1093/cid/ciaa270

Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China

Pingzheng Mo 1,#, Yuanyuan Xing 2,#, Yu Xiao 2,#, Liping Deng 1,#, Qiu Zhao 3, Hongling Wang 3, Yong Xiong 1, Zhenshun Cheng 4, Shicheng Gao 1, Ke Liang 1, Mingqi Luo 1, Tielong Chen 1, Shihui Song 1, Zhiyong Ma 1, Xiaoping Chen 1, Ruiying Zheng 1, Qian Cao 1, Fan Wang 3,, Yongxi Zhang 1,
PMCID: PMC7184444  PMID: 32173725

Abstract

Background

Since December 2019, novel coronavirus (SARS-CoV-2)-infected pneumonia (COVID-19) occurred in Wuhan, and rapidly spread throughout China. This study aimed to clarify the characteristics of patients with refractory COVID-19.

Methods

In this retrospective single-center study, we included 155 consecutive patients with confirmed COVID-19 in Zhongnan Hospital of Wuhan University from January 1st to February 5th. The cases were divided into general and refractory COVID-19 groups according to the clinical efficacy after hospitalization, and the difference between groups were compared.

Results

Compared with general COVID-19 patients (45.2%), refractory patients had an older age, male sex, more underlying comorbidities, lower incidence of fever, higher levels of maximum temperature among fever cases, higher incidence of breath shortness and anorexia, severer disease assessment on admission, high levels of neutrophil, aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and C-reactive protein, lower levels of platelets and albumin, and higher incidence of bilateral pneumonia and pleural effusion (P<0.05). Refractory COVID-19 patients were more likely to receive oxygen, mechanical ventilation, expectorant, and adjunctive treatment including corticosteroid, antiviral drugs and immune enhancer (P<0.05). After adjustment, those with refractory COVID-19 were also more likely to have a male sex and manifestations of anorexia and fever on admission, and receive oxygen, expectorant and adjunctive agents (P<0.05) when considering the factors of disease severity on admission, mechanical ventilation, and ICU transfer.

Conclusion

Nearly 50% COVID-19 patients could not reach obvious clinical and radiological remission within 10 days after hospitalization. The patients with male sex, anorexia and no fever on admission predicted poor efficacy.

Keywords: COVID-19, SARS-CoV-2, clinical efficacy, predictors


Articles from Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America are provided here courtesy of Oxford University Press

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