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Objective:  To describe the clinical manifestations and outcomes of COVID-19, and explore the risk factors of deterioration and death of the disease.   Methods:  In this retrospective study, we collected data from 121 COVID-19 cases confirmed by RT-PCR and next-generation sequencing in Renmin Hospital of Wuhan University from January 30, 2019, to March 23, 2020, and conducted statistical analysis.   Results:  A total of 121 patients were included in our study, the median age was 65 years (IQR, 55.0–71.5 years), and 54.5% cases were men. Among those cases, 52 (43.0%) cases progressed to severe, and 14 (11.6%) died. Overall, the most common manifestations were fever (78.5%) and respiratory symptoms (77.7%), while neurological symptoms were found in only 9.9% of the patients. 70.2% of all the cases had comorbidities, including hypertension (40.5%) and diabetes (20.7%). On admission, cases usually show elevated levels of neutrophils (27.3%), D-dimer (72.6%), Interleukin-6 (35.2%), Interleukin-10 (64.4%), high-sensitivity C-reactive protein (82.6%), and lactate dehydrogenase (62.0%), and decreased levels of lymphocytes (66.9%), CD3 cells (67.2%), and CD4 cells (63.0%). The proportional hazard Cox models showed that the risk factors for severity progression and death included comorbidities (HR: 4.53, 95% CI: 1.78–11.55 and HR: 7.81, 95% CI: 1.02–59.86), leukocytosis (HR: 1.13; 95% CI: 1.05–1.22 and HR: 1.25, 95% CI: 1.10–1.42), neutrophilia (HR: 1.15, 95% CI: 1.07–1.13 and HR: 1.28, 95% CI: 1.13–1.46, and elevated LDH (HR: 1.14, 95% CI: 1.12–1.15 and HR: 1.11, 95% CI: 1.10–1.12). Elevated D-dimer (HR: 1.02, 95% CI: 1.01–1.03), IL-6 (HR: 1.01, 95% CI: 1.00–1.02) and IL-10 levels (HR: 1.04, 95% CI: 1.01–1.07) were also risk factors for the progression of disease severity. Meanwhile, lymphopenia and wake immune responses [e.g., lower CD3, CD4, or CD19 counts (all HR < 1)] were associated with disease deterioration and death.   Conclusions:  Severe cases and death of COVID-19 are associated with older age, comorbidities, organ dysfunction, lymphopenia, high cytokines, and weak immune responses.

Clinical Characteristics and Risk Factors for Disease Severity and Death in Patients With Coronavirus Disease 2019 in Wuhan, China