Clinical characteristics and risk factors for severe-critically ill COVID-19 adult patients in Jiangsu, China: a multiple-centered, retrospective study

Background A number of reports have documented the clinical characteristics of patients with severe coronavirus disease 2019 (COVID-19) in Wuhan. Clinical features of severe-critically ill COVID-19 patients in Jiangsu, outside Wuhan, remains unknown. Methods This multi-centered retrospective study collected the information of 631 laboratory-confirmed COVID-19 patients hospitalized at 28 authorized hospitals in Jiangsu province between January 23, 2019 and March 13, 2020. Epidemiological and demographic information, clinical and radiological characteristics, laboratory results and treatment of these patients were analyzed. Results A total of 583 adult patients with laboratory-confirmed COVID-19 were enrolled for final analysis, including 84 severe-critically ill patients and 499 mild-moderate patients. Median age of the severe-critically ill patients was 57.0 years [interquartile range (IQR), 49.0-65.8], and 50 (59.5%) were males. Multisystemic laboratory abnormalities were observed on admission in severe-critically ill patients. The severe-critically ill patients showed more noticeable radiologic abnormalities and more coexisting health issues as compared to mild-moderate patients. Most of the severe-critically ill COVID-19 patients become deteriorated in two weeks after diagnosis. Age [odds ratio (OR) 1.08, 95% confidence interval (CI) (1.03-1.14)], D-dimer (OR 3.21, 95% CI 1.39-7.40), and lymphocytes (OR 0.28, 95% CI 0.04-0.88) were independently associated with the progression of severe-critically illness. Conclusions Older age, higher D-dimer levels and less lymphocyte counts on admission are potential risk factors for COVID-19 patients to develop into severe and critically illness. The results would help clinicians to identify high-risk patients in advance.

Treatment of Severe COVID-19 with human Umbilical Cord Mesenchymal Stem Cells

Background COVID-19 is a highly infectious respiratory disease. No effective therapeutics have yet been proved for treating of severe COVID-19. Objectives To determine whether human Umbilical Cord Mesenchymal Stem Cells infusion may be effectiveness and safety in the treatment of severe COVID-19. Methods The severe COVID-19 randomly divided into 2 groups, standard treatment group and standard treatment plus hUC-MSCs infusion group. The incidence of severe patients aggravated to critically illness, 28-day mortality, clinical symptoms improvement, time to clinical symptoms improvement, hematologic indicators including C-reaction protein, lymphocyte number, interleukin 6 and imaging changes were observed and compared between two groups. Measurements and Main Results The incidence of severe patients aggravated to critically illness and 28-day mortality were 0 in hUC-MSCs treatment group, while 4 patients in control group were deteriorated to critical illness and been used invasive ventilation, 3 of them died, and 28-day mortality was 10.34%. In hUC-MSCs treatment group, the time to clinical improvement was shorter, clinical symptoms of weakness and fatigue, shortness of breath, and low oxygen saturation had improved obviously began the third day of stem cells infusion, and reached the significant difference on the day 7, CRP and IL-6 were significantly decreased from day 3 of infusion, the time for lymphocyte count returned to normal range was significant faster, and lung inflammation absorption was significantly shorter from CT imaging. Conclusions Intravenous transplantation of hUC-MSCs is a safe and effective way that can be considered as salvage and priority choice in the treatment of severe COVID-19.