Multi-Organ Damage of Critically Ill Patients with Hyoxemia Affected by SARS-CoV-2 Infection

Objective: To study the epidemiology details and clinical features of hypoxic patients infected with SARS-CoV-2 infection that admitted to Renmin Hospital of Wuhan University. Design: Retrospective case series. Setting: Renmin Hospital of Wuhan University, Wuhan, China. Participants: 73 hypoxic patients admitted to hospital with laboratory confirmed SARS-Cov-2 infection. Data were collected from February 1 to February 28, 2020. Main Outcome Measures: The medical records of epidemiological, clinical, laboratory, and radiological characteristics, treatment and management outcome data were entered into standardized data collection form in electronic medical records. Results: The study cohort comprised 73 hypoxic patients with SARS-CoV-2 infection. The median age was 66 years and 40 (54.8%) were male. Underlying chronic medical disorders were highly prevalent. Lymphocyte absolute value was below the normal range appeared in 61 (83.6%) patients. Concomitant bacterial infection (26 [35.6%]) or sepsis (14 [19.2%]) was found in some patients. Level of IL-6 was obviously increased to 31.5pg/ml (IQR 16.5-70.9). Absolute value of CD3+, CD4+ and CD8+ T cells decreased dramatically, which highlights there was a general decline in cellular immune function. 28 (38.4%) patients were immediately diagnosed as hypoxemia upon first hospital admission. The median duration from normal oxygen saturation to the onset of hypoxemia was 2 days (IQR, 2-4). The mean time of hypoxemia onset after admission had no obvious correlation with whether the patients received glucocorticoid therapy, gamma globulin therapy, α-interferons therapy or not. After 14d (IQR 8-20) during admission, 33.3% patients were presented with a persistent increasement in myocardial injury biomarkers and the median Troponin I content was 6.25 times higher than the normal high limit. Level of NT-ProBNP was elevated in 17 (24.6%) patients and the median content was 2018 pg/mL (IQR 1052-5180) corroding to different ages. After symptomatic treatment, approximately 15% patients remained a slightly disorder of hepatic and renal function within observation period. Conclusion: In this single-center case series of 73 hypoxic patients with SARS-CoV-2 infection, a general decline in cellular immune function was observed with inflammatory response activation. Cardiac, hepatic and renal functions were slightly impaired. Until now, there was no evident improvement in the average time for the onset of hypoxemia after traditional therapy. The development of specific therapies to strengthen cellular immunity may be more conducive to relieving illness and improving prognosis. Funding Statement: This work was supported by the National Natural Science Foundation of China (81570331). Declaration of Interest: None. All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure. pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: The study was reviewed and approved by the Institutional Ethics Committee of Renmin Hospital of Wuhan university (Authorization number: WDRY2020-K045).