Clinical characteristics of death and recovered cases of COVID-19 patients with endotracheal intubation

Ling Zhou¹, Wei Liu², Kui Liu¹, Yan Deng¹, YuanYuan Fang¹, HuoJun Zhang¹, Miao Luo¹, HuiGuo Liu^1*

¹Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China - ²Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei 430060, China

Introduction: To investigate the clinical characteristics of endotracheal intubation patients who died or recovered from coronavirus disease 2019 (COVID-19) and factors related to death or recovery. 

Materials and methods: A total of 126 patients diagnosed with COVID-19 with endotracheal intubation were included in this study. Personal information, laboratory tests, imaging studies, and clinical data were collected to analyze the clinical characteristics of endotracheal intubation patients who died or recovered from COVID-19. 

Results: 1. A significantly higher proportion of patients in the death group received antibiotic therapy and glucocorticoid dosage than those in the recovery group (P<0.05). The time from admission to intubation and complications after intubation was significantly longer in the death group than in the recovery group (P<0.05). The proportion of use Extracorporeal Membrane Oxygenation(ECMO) was significantly lower in the death group than in the recovery group (P<0.05). 2. The patients in 3the death group were significantly older, and a significantly higher proportion of the patients in the death group than in the recovery group were men or were smokers (P<0.05). The comorbidities and proportion of post-intubation infection was significantly higher in the death group than in the recovery group (P<0.05). The admission time was significantly earlier in the death group than in the recovery group (P<0.05). 3. There was more pronounced in the death group in terms of both the proportion of patients with this symptom and its severity (P<0.05). The blood oxygen saturation level was significantly lower and the respiratory rate was significantly higher in the death group than in the recovery group (P<0.05). 4. Pretreatment (at admission) white blood cells, neutrophils, D-dimers, aspartate aminotransferase, procalcitonin, and C-reactive protein and posttreatment white blood cells, neutrophils, aspartate aminotransferase, creatinine, erythrocyte sedimentation rate, procalcitonin, and C-reactive protein were significantly higher in the death group than in the recovery group (P<0.05). Pretreatment lymphocytes, albumin, and oxygen partial pressure and posttreatment albumin and oxygen partial pressure were significantly lower in the death group than in the recovery group (P<0.05). Laboratory tests showed that in the recovery group, white blood cells, lymphocytes, neutrophils, and platelets were significantly increased after treatment, and aspartate aminotransferase and C-reactive protein were significantly decreased after treatment (P<0.05). White blood cells, neutrophils, BNP and platelets were also significantly increased after treatment in the death group (P<0.05). 

Conclusion: Advanced age, smoking, high fever, time from admission to intubation, ECMO, complications and infection after intubation, rapid respiratory rate, low oxygen saturation are adverse prognostic factors.