Advertisement
Mayo Clinic Proceedings Home

Clinical Characteristics, Treatment, and Outcomes of Critically Ill Patients With COVID-19: A Scoping Review

Published:October 26, 2020DOI:https://doi.org/10.1016/j.mayocp.2020.10.022

      Abstract

      A growing number of studies on coronavirus disease 2019 (COVID-19) are becoming available, but a synthesis of available data focusing on the critically ill population has not been conducted. We performed a scoping review to synthesize clinical characteristics, treatment, and clinical outcomes among critically ill patients with COVID-19. Between January 1, 2020, and May 15, 2020, we identified high-quality clinical studies describing critically ill patients with a sample size of greater than 20 patients by performing daily searches of the World Health Organization and LitCovid databases on COVID-19. Two reviewers independently reviewed all abstracts (2785 unique articles), full text (218 articles), and abstracted data (92 studies). The 92 studies included 61 from Asia, 16 from Europe, 10 from North and South America, and 5 multinational studies. Notable similarities among critically ill populations across all regions included a higher proportion of older males infected and with severe illness, high frequency of comorbidities (hypertension, diabetes, and cardiovascular disease), abnormal chest imaging findings, and death secondary to respiratory failure. Differences in regions included newly identified complications (eg, pulmonary embolism) and epidemiological risk factors (eg, obesity), less chest computed tomography performed, and increased use of invasive mechanical ventilation (70% to 100% vs 15% to 47% of intensive care unit patients) in Europe and the United States compared with Asia. Future research directions should include proof-of-mechanism studies to better understand organ injuries and large-scale collaborative clinical studies to evaluate the efficacy and safety of antivirals, antibiotics, interleukin 6 receptor blockers, and interferon. The current established predictive models require further verification in other regions outside China.

      Abbreviations and Acronyms:

      ACEI (angiotensin-converting enzyme inhibitor), APACHE (Acute Physiology and Chronic Health Evaluation), ARB (angiotensin receptor blocker), ARDS (acute respiratory distress syndrome), COVID-19 (coronavirus disease 2019), CRP (C-reactive protein), CT (computed tomography), EUA (emergency use authorization), HFNC (high-flow nasal cannula oxygen therapy), ICU (intensive care unit), IF (impact factor), IL (interleukin), IMV (invasive mechanical ventilation), LOS (length of stay), NIMV (noninvasive mechanical ventilation), PE (pulmonary embolism), RCT (randomized clinical trial), SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), SOFA (Sequential Organ Failure Assessment)
      Article Highlights
      • This scoping review is the first of its kind to synthesize the current literature focusing on patients with coronavirus disease 2019 and critical illness by analyzing 92 included studies from Asia, Europe, and North and South America.
      • Scoping reviews are valuable for summarizing existing knowledge, highlighting gaps in our understanding, and guiding future research directions.
      • Notable similarities among critically ill populations across all regions included a higher proportion of older males infected and with severe illness, high frequency of comorbidities, abnormal chest imaging findings, and death secondary to respiratory failure. Differences in regions included newly identified complications (eg, pulmonary embolism) and epidemiological risk factors (eg, obesity), and a longer stay in the intensive care unit, less chest computed tomography performed, and increased use of mechanical ventilation (70% to 100% vs 15% to 47% of intensive care unit patients) in Europe and the United States compared with China.
      • Future research directions include a need for studies to confirm the mechanism of organ injuries and large-scale collaborative clinical studies to evaluate the efficacy and safety of drugs. The current established predictive models require further verification in other regions outside China.
      Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), is the novel coronavirus first detected in Wuhan, China, in December 2019
      • Zhu N.
      • Zhang D.
      • Wang W.
      • et al.
      China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019.
      ,
      • Wu Z.
      • McGoogan J.M.
      Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.
      that continues to spread globally, with more than 13 million cases confirmed as of July 15, 2020. The clinical spectrum of COVID-19 ranges widely from asymptomatic infection to critical illness with a high risk of mortality.
      • Huang C.
      • Wang Y.
      • Li X.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020;395(10223):496].
      • Zhou F.
      • Yu T.
      • Du R.
      • et al.
      Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published corrections appear in Lancet. 2020;395(10229):1038].
      Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19).
      Based on the evidence to date, there is a high probability of requirement for intensive care unit (ICU) level of care among patients with COVID-19, leading to a substantial increase in the demand for critical care beds. Understanding the disease trajectory and those most likely to benefit from critical care will be vital for ICU clinicians as they grapple with this new illness and understand how best to manage patients within potentially resource-constrained settings.
      Because there are limited antiviral treatment options for COVID-19 and the severity of disease is closely related to the prognosis,
      • Zhou F.
      • Yu T.
      • Du R.
      • et al.
      Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published corrections appear in Lancet. 2020;395(10229):1038].
      it is also essential to triage patients with COVID-19 and identify early from among the many mild cases the few who will have progression to critical illness to effectively prioritize resources for patients with the highest risk, keep them under continuous close monitoring, and intervene as needed to prevent the progression of disease.
      As a growing body of literature on COVID-19 is becoming available, a small number of systematic and scoping reviews have been published since February 2020. However, because of the relatively short time since the outbreak of this novel disease, most reviews have either focused on a single aspect of COVID-19 (eg, imaging findings,
      • Salehi S.
      • Abedi A.
      • Balakrishnan S.
      • Gholamrezanezhad A.
      Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients.
      comorbidities,
      • Yang J.
      • Zheng Y.
      • Gou X.
      • et al.
      Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis.
      treatment
      • Vijayvargiya P.
      • Esquer Garrigos Z.
      • Castillo Almeida N.E.
      • Gurram P.R.
      • Stevens R.W.
      • Razonable R.R.
      Treatment considerations for COVID-19: a critical review of the evidence (or lack thereof).
      ) or included a very limited number of studies with minimal quantitative data synthesis,
      • Sun P.
      • Qie S.
      • Liu Z.
      • Ren J.
      • Li K.
      • Xi J.
      Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: a single arm meta-analysis.
      or primarily described disease features among the general population
      • Adhikari S.P.
      • Meng S.
      • Wu Y.-J.
      • et al.
      Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review.
      and often included studies from a single country.
      • Herman C.
      • Mayer K.
      • Sarwal A.
      Scoping review of prevalence of neurologic comorbidities in patients hospitalized for COVID-19.
      ,
      • Zheng Z.
      • Peng F.
      • Xu B.
      • et al.
      Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis.
      Initial research emerged from Asia, but more COVID-19 studies from Europe and North America have now been published. What is missing from the current literature, however, is a synthesis of the worldwide literature on critically ill patients specifically. Given the urgency of the COVID-19 epidemic and the need to understand information about critically ill patients with COVID-19, a scoping review was considered suitable and useful for mapping the available evidence to identify knowledge gaps.
      • Munn Z.
      • Peters M.D.J.
      • Stern C.
      • Tufanaru C.
      • McArthur A.
      • Aromataris E.
      Systematic review or scoping review? guidance for authors when choosing between a systematic or scoping review approach.
      This study had several objectives. First, we wanted to synthesize the current and emerging literature describing the clinical features, treatment, outcomes, and risk factors associated with poor prognosis among critically ill patients with COVID-19 during the early months of the pandemic. Second, we wanted to provide frontline clinicians with insights for the effective management of severely ill patients with COVID-19. Finally, we aimed to identify knowledge gaps to guide future research endeavors.

      Methods

      We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist in reporting findings.
      • Tricco A.C.
      • Lillie E.
      • Zarin W.
      • et al.
      PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.

      Data Source and Search Strategy

      We identified eligible studies daily by searching the World Health Organization COVID-19 database
      World Health Organization
      COVID-19: global literature on coronavirus disease.
      and the LitCovid database
      • Chen Q.
      • Allot A.
      • Lu Z.
      Keep up with the latest coronavirus research [letter].
      ,
      National Center for Biotechnology Information
      LitCovid database.
      for COVID-19 literature published in English from January 1, 2020, to May 15, 2020. Both of these databases track and provide daily updates on COVID-19 scientific studies. To focus our efforts, we included peer-reviewed human studies in clinical journals with an impact factor (IF) of greater than 5. We did not include studies on animals or those examining molecular disease mechanisms. We imported the identified articles into Covidence systematic review software for the title, abstract, and full-text screening.

      Study Selection

      Studies that met all of the following criteria were included: (1) analysis included full cohort or subgroup of critically ill adult patients with COVID-19; defined in our study as patients admitted to the ICU, those categorized with severe disease by guidelines, end-organ injury/dysfunction, and patients who died from COVID-19; (2) reporting at least one of the following types of information: clinical characteristics, treatment, or use of multivariate analysis of risk factors associated with higher disease severity or poor prognosis; (3) study designs: randomized clinical trials (RCT), prospective or retrospective observational studies; and (4) sample size of 20 or more individual patients.
      Studies were excluded on the basis of one or more of the following: (1) participants younger than 18 years, pregnant women, no analysis of critically ill patients; (2) study designs were research letters without patient data, news reports, editorials, commentaries, case reports, mathematical modeling studies, recommendations, guidelines, or review articles; and (3) non-English articles.
      All titles and abstracts screened in the first phase, as well as full-text articles in the second phase, were reviewed independently by 2 investigators (C.H., J.S., S.H., Y.P., or K.P.). Discrepancies were resolved by a senior team member (Y.D. or A.K.B.) in each phase. Reasons for exclusion are reported in the PRISMA-ScR flowchart (Figure). During the process of gathering and reviewing information, we modified the inclusion and exclusion criteria as new ideas emerged and ensured that the previous steps complied with the change in protocol.
      Figure thumbnail gr1
      FigurePRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram for the scoping review process. aAfter May 15, 2020, when we had discontinued daily updates, we included one study describing a randomized clinical trial meeting inclusion criteria. ICU, intensive care unit.

      Data Extraction and Synthesis

      Data abstraction on each of the included articles was performed by 2 independent reviewers (C.H., J.S., S.H., Y.P., or K.P.) using a tailored Excel (Microsoft) form, which was piloted beforehand. Data abstracted included the following: literature characteristics (eg, journal, publication date, title, first author), characteristics related to study method (eg, article type, study design, country where the study was conducted, sample size, subgroups divided), variables related to patient clinical characteristics (eg, demographic characteristics, comorbidities, symptoms, laboratory findings, imaging assessments, severity of illness), interventions (eg, drug treatments, oxygen supplies, mechanical ventilation), clinical outcomes (eg, discharge, severity of disease, mortality, hospital length of stay [LOS]), risk factors associated with severity of illness or prognosis as identified using multivariate analysis, and key findings. As the data extraction process unfolded, we also enhanced the data extraction form, with new or more precise categories as needed. Reviewers also had regular meetings to address any challenges and to ensure concordance with their abstraction methods.
      For data analysis, we descriptively summarized and qualitatively synthesized the data. The findings are presented in a narrative form, including tables and figures, to aid in data presentation and interpretation where appropriate.

      Results

      Literature Characteristics

      The literature search generated 3172 records. Of these, 387 were duplicates and 2567 were excluded. A full-text review was conducted on 218 studies, and 127 were excluded because they did not meet our criteria. One additional relevant RCT study was included for data synthesis. A total of 92 studies were included for data abstraction (Figure).

      Characteristics of Included Studies

      Table 1 summarizes the main characteristics of the 92 included studies, 54 (59%) of which were original articles and 35 (38%) were research letters. Study designs were primarily retrospective observational studies (83 [90%]), followed by RCTs (5 [5%]) and prospective observational studies (4 [4%]). Nearly half of them were multicenter studies. Geographically, the articles largely originated in Asian countries (61 [66%]), followed by European countries (16 [17%]), North or South American countries (10 [11%]), and multinational regions (5 [5%]). The sample size ranged from 20 to 44,672 patients, with over one-half of the studies including more than 100 patients. Of the 92 studies, 28 [30%] analyzed a full cohort, and the other studies included 1 or 2 subgroups of critically ill patients with COVID-19. The definition of what constituted critical illness varied in the studies, characterized as patients admitted to the ICU (23 studies [25%]),
      • Huang C.
      • Wang Y.
      • Li X.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020;395(10223):496].
      ,
      • Zou X.
      • Li S.
      • Fang M.
      • et al.
      Acute Physiology and Chronic Health Evaluation II score as a predictor of hospital mortality in patients of coronavirus disease 2019.
      • Bessière F.
      • Roccia H.
      • Delinière A.
      • et al.
      Assessment of QT intervals in a case series of patients with coronavirus disease 2019 (COVID-19) infection treated with hydroxychloroquine alone or in combination with azithromycin in an intensive care unit.
      • Grasselli G.
      • Zangrillo A.
      • Zanella A.
      • et al.
      COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy.
      • Kandemirli S.G.
      • Dogan L.
      • Sarikaya Z.T.
      • et al.
      Brain MRI findings in patients in the intensive care unit with COVID-19 infection.
      • Arentz M.
      • Yim E.
      • Klaff L.
      • et al.
      Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.
      • Myers L.C.
      • Parodi S.M.
      • Escobar G.J.
      • Liu V.X.
      Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.
      • Shen L.
      • Li S.
      • Zhu Y.
      • et al.
      Clinical and laboratory-derived parameters of 119 hospitalized patients with coronavirus disease 2019 in Xiangyang, Hubei Province, China.
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      • Wang Y.
      • Lu X.
      • Li Y.
      • et al.
      Clinical course and outcomes of 344 intensive care patients with COVID-19.
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020;8(4):e26].
      • Tang X.
      • Du R.-H.
      • Wang R.
      • et al.
      Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1.
      • Lee J.
      • Lee Y.H.
      • Chang H.-H.
      • et al.
      Comparison of short-term mortality between mechanically ventilated patients with COVID-19 and influenza in a setting of sustainable healthcare system.
      • Bhatraju P.K.
      • Ghassemieh B.J.
      • Nichols M.
      • et al.
      Covid-19 in critically ill patients in the Seattle region - case series.
      • Borba M.G.S.
      • Val F.F.A.
      • Sampaio V.S.
      • et al.
      CloroCovid-19 Team
      Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a randomized clinical trial.
      • Xie Y.
      • Cao S.
      • Dong H.
      • et al.
      Effect of regular intravenous immunoglobulin therapy on prognosis of severe pneumonia in patients with COVID-19.
      • Helms J.
      • Tacquard C.
      • Severac F.
      • et al.
      CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)
      High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study.
      • Wu C.-N.
      • Xia L.-Z.
      • Li K.-H.
      • et al.
      High-flow nasal-oxygenation-assisted fibreoptic tracheal intubation in critically ill patients with COVID-19 pneumonia: a prospective randomised controlled trial.
      • Cardoso F.S.
      • Pereira R.
      • Germano N.
      Liver injury in critically ill patients with COVID-19: a case series.
      • Helms J.
      • Kremer S.
      • Merdji H.
      • et al.
      Neurologic features in severe SARS-CoV-2 infection.
      • Poissy J.
      • Goutay J.
      • Caplan M.
      • et al.
      Lille ICU Haemostasis COVID-19 Group
      Pulmonary embolism in patients with COVID-19: awareness of an increased prevalence.
      • Ziehr D.R.
      • Alladina J.
      • Petri C.R.
      • et al.
      Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.
      • Criel M.
      • Falter M.
      • Jaeken J.
      • et al.
      Venous thromboembolism in SARS-CoV-2 patients: only a problem in ventilated ICU patients, or is there more to it?.
      severe COVID-19 defined by Chinese guidelines (25 studies [27%])
      • Li J.
      • Wang X.
      • Chen J.
      • Zhang H.
      • Deng A.
      Association of renin-angiotensin system inhibitors with severity or risk of death in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19) infection in Wuhan, China.
      • Shi S.
      • Qin M.
      • Cai Y.
      • et al.
      Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019.
      • Tian S.
      • Hu N.
      • Lou J.
      • et al.
      Characteristics of COVID-19 infection in Beijing.
      • Xu Y.-H.
      • Dong J.-H.
      • An W.-M.
      • et al.
      Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2.
      • Chen G.
      • Wu D.
      • Guo W.
      • et al.
      Clinical and immunological features of severe and moderate coronavirus disease 2019.
      • Ma J.
      • Yin J.
      • Qian Y.
      • Wu Y.
      Clinical characteristics and prognosis in cancer patients with COVID-19: a single center's retrospective study.
      • Pan L.
      • Mu M.
      • Yang P.
      • et al.
      Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study.
      • Zhou B.
      • She J.
      • Wang Y.
      • Ma X.
      The clinical characteristics of myocardial injury in severe and very severe patients with 2019 novel coronavirus disease.
      • Chen L.
      • Zhang B.
      • Ti M.-Y.-D.-L.N.-J.
      • Yang K.
      • Zou Y.
      • Zhang S.
      Clinical course of severe and critically ill patients with coronavirus disease 2019 (COVID-19): a comparative study.
      • Feng Y.
      • Ling Y.
      • Bai T.
      • et al.
      COVID-19 with different severities: a multicenter study of clinical features.
      • Chen X.
      • Zhao B.
      • Qu Y.
      • et al.
      Detectable serum severe acute respiratory syndrome coronavirus 2 viral load (RNAemia) is closely correlated with drastically elevated interleukin 6 level in critically ill patients with coronavirus disease 2019.
      • Qin C.
      • Zhou L.
      • Hu Z.
      • et al.
      Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China.
      • Wu J.
      • Li W.
      • Shi X.
      • et al.
      Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19).
      • Shi Y.
      • Yu X.
      • Zhao H.
      • Wang H.
      • Zhao R.
      • Sheng J.
      Host susceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan.
      • Wang C.
      • Fei D.
      • Li X.
      • Zhao M.
      • Yu K.
      IL-6 may be a good biomarker for earlier detection of COVID-19 progression.
      • Fang X.
      • Mei Q.
      • Yang T.
      • et al.
      Low-dose corticosteroid therapy does not delay viral clearance in patients with COVID-19.
      • Wang Y.
      • Zhang D.
      • Du G.
      • et al.
      Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial [published correction appears in Lancet. 2020;395(10238):1694].
      • Hu L.
      • Chen S.
      • Fu Y.
      • et al.
      Risk Factors associated with clinical outcomes in 323 coronavirus disease 2019 (COVID-19) hospitalized patients in Wuhan, China.
      • Liu X.
      • Zhou H.
      • Zhou Y.
      • et al.
      Risk factors associated with disease severity and length of hospital stay in COVID-19 patients.
      • Wei Y.-Y.
      • Wang R.-R.
      • Zhang D.-W.
      • et al.
      Risk factors for severe COVID-19: evidence from 167 hospitalized patients in Anhui, China.
      • Li H.
      • Xiang X.
      • Ren H.
      • et al.
      Serum amyloid A is a biomarker of severe coronavirus disease and poor prognosis.
      • Long L.
      • Zeng X.
      • Zhang X.
      • et al.
      Short-term outcomes of COVID-19 and risk factors for progression.
      • Xu B.
      • Fan C.-Y.
      • Wang A.-L.
      • et al.
      Suppressed T cell-mediated immunity in patients with COVID-19: a clinical retrospective study in Wuhan, China.
      • Gong J.
      • Ou J.
      • Qiu X.
      • et al.
      A tool for early detection of severe coronavirus disease 2019 (COVID-19): a multicenter study using the risk nomogram in Wuhan and Guangdong, China [published online ahead of print, 2020 Apr 16].
      • Zheng S.
      • Fan J.
      • Yu F.
      • et al.
      Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study.
      or American Thoracic Society guidelines (3 studies [3%]),
      • Guan W.-J.
      • Ni Z.-Y.
      • Hu Y.
      • et al.
      Clinical characteristics of coronavirus disease 2019 in China.
      • Liang W.
      • Liang H.
      • Ou L.
      • et al.
      China Medical Treatment Expert Group for COVID-19
      Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19.
      • Mao L.
      • Jin H.
      • Wang M.
      • et al.
      Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.
      patients with organ injury or dysfunction (23 studies [25%]),
      • Wei J.-F.
      • Huang F.-Y.
      • Xiong T.-Y.
      • et al.
      Acute myocardial injury is common in patients with COVID-19 and impairs their prognosis.
      • Léonard-Lorant I.
      • Delabranche X.
      • Séverac F.
      • et al.
      Acute pulmonary embolism in patients with COVID-19 at CT angiography and relationship to D-dimer levels.
      • Xie J.
      • Covassin N.
      • Fan Z.
      • et al.
      Association between hypoxemia and mortality in patients with COVID-19.
      • Shi S.
      • Qin M.
      • Shen B.
      • et al.
      Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China.
      • Guo T.
      • Fan Y.
      • Chen M.
      • et al.
      Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19).
      • Colaneri M.
      • Sacchi P.
      • Zuccaro V.
      • et al.
      COVID19 IRCCS San Matteo Pavia Task Force
      Clinical characteristics of coronavirus disease (COVID-19) early findings from a teaching hospital in Pavia, North Italy, 21 to 28 February 2020.
      • Goyal P.
      • Choi J.J.
      • Pinheiro L.C.
      • et al.
      Clinical characteristics of Covid-19 in New York City.
      • Wang Z.
      • Yang B.
      • Li Q.
      • Wen L.
      • Zhang R.
      Clinical features of 69 cases with coronavirus disease 2019 in Wuhan, China.
      • Su Y.
      • Tu G.-W.
      • Ju M.-J.
      • et al.
      Comparison of CRB-65 and quick sepsis-related organ failure assessment for predicting the need for intensive respiratory or vasopressor support in patients with COVID-19.
      • Grein J.
      • Ohmagari N.
      • Shin D.
      • et al.
      Compassionate use of remdesivir for patients with severe Covid-19.
      • Geleris J.
      • Sun Y.
      • Platt J.
      • et al.
      Observational study of hydroxychloroquine in hospitalized patients with Covid-19.
      • Ji D.
      • Zhang D.
      • Xu J.
      • et al.
      Prediction for progression risk in patients with COVID-19 pneumonia: the CALL score.
      • Bompard F.
      • Monnier H.
      • Saab I.
      • et al.
      Pulmonary embolism in patients with COVID-19 pneumonia.
      • Beigel J.H.
      • Tomashek K.M.
      • Dodd L.E.
      • et al.
      ACTT-1 Study Group Members
      Remdesivir for the treatment of Covid-19 - preliminary report.
      • Wu C.
      • Chen X.
      • Cai Y.
      • et al.
      Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China.
      • Rovina N.
      • Akinosoglou K.
      • Eugen-Olsen J.
      • Hayek S.
      • Reiser J.
      • Giamarellos-Bourboulis E.J.
      Soluble urokinase plasminogen activator receptor (suPAR) as an early predictor of severe respiratory failure in patients with COVID-19 pneumonia.
      • Stefanini G.G.
      • Montorfano M.
      • Trabattoni D.
      • et al.
      ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes.
      • Cao B.
      • Wang Y.
      • Wen D.
      • et al.
      A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19.
      • Pereira M.R.
      • Mohan S.
      • Cohen D.J.
      • et al.
      COVID-19 in solid organ transplant recipients: initial report from the US epicenter.
      • Mo P.
      • Xing Y.
      • Xiao Y.
      • et al.
      Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China.
      • Grillet F.
      • Behr J.
      • Calame P.
      • Aubry S.
      • Delabrousse E.
      Acute pulmonary embolism associated with COVID-19 pneumonia detected with pulmonary CT angiography.
      • Colombi D.
      • Bodini F.C.
      • Petrini M.
      • et al.
      Well-aerated lung on admitting chest CT to predict adverse outcome in COVID-19 pneumonia.
      • Rosenberg E.S.
      • Dufort E.M.
      • Udo T.
      • et al.
      Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State.
      and those who died of COVID-19 (18 studies [20%]).
      • Zhou F.
      • Yu T.
      • Du R.
      • et al.
      Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published corrections appear in Lancet. 2020;395(10229):1038].
      ,
      • Wang K.
      • Zhang Z.
      • Yu M.
      • Tao Y.
      • Xie M.
      15-Day mortality and associated risk factors for hospitalized patients with COVID-19 in Wuhan, China: an ambispective observational cohort study.
      • Mehra M.R.
      • Desai S.S.
      • Kuy S.
      • Henry T.D.
      • Patel A.N.
      Cardiovascular disease, drug therapy, and mortality in Covid-19 [retracted in: N Engl J Med. 2020;382(26):2582].
      • Inciardi R.M.
      • Adamo M.
      • Lupi L.
      • et al.
      Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.
      • Li W.
      • Zhang J.
      • Xiao S.
      • Sun L.
      Characteristics of deaths amongst health workers in China during the outbreak of COVID-19 infection.
      • Wang K.
      • Zuo P.
      • Liu Y.
      • et al.
      Clinical and laboratory predictors of in-hospital mortality in patients with coronavirus disease 2019: a cohort study in Wuhan, China.
      • Chen T.
      • Wu D.
      • Chen H.
      • et al.
      Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020;368:m1295].
      • Wang D.
      • Yin Y.
      • Hu C.
      • et al.
      Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.
      • Deng G.
      • Yin M.
      • Chen X.
      • Zeng F.
      Clinical determinants for fatality of 44,672 patients with COVID-19.
      • Cao J.
      • Tu W.-J.
      • Cheng W.
      • et al.
      Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China].
      • Du Y.
      • Tu L.
      • Zhu P.
      • et al.
      Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study.
      • Tomlins J.
      • Hamilton F.
      • Gunning S.
      • Sheehy C.
      • Moran E.
      • MacGowan A.
      Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the first UK cohort.
      • Ruan Q.
      • Yang K.
      • Wang W.
      • Jiang L.
      • Song J.
      Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China [published correction appears in Intensive Care Med. 2020;46(6):1294-1297].
      • Tu W.-J.
      • Cao J.
      • Yu L.
      • Hu X.
      • Liu Q.
      Clinicolaboratory study of 25 fatal cases of COVID-19 in Wuhan.
      • Wang L.
      • He W.
      • Yu X.
      • et al.
      Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up.
      • Webb G.J.
      • Moon A.M.
      • Barnes E.
      • Barritt A.S.
      • Marjot T.
      Determining risk factors for mortality in liver transplant patients with COVID-19.
      • Richardson S.
      • Hirsch J.S.
      • Narasimhan M.
      • et al.
      Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area [published correction appears in JAMA. 2020;323(20):2098].
      • Chen R.
      • Liang W.
      • Jiang M.
      • et al.
      Medical Treatment Expert Group for COVID-19
      Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China.
      Table 1Characteristics of the 92 Included Studies
      COVID-19, coronavirus disease 2019; ICU, intensive care unit; RCT, randomized clinical trial.
      CharacteristicNo. (%) of studies
      Percentages may not total 100 because of rounding.
      Journal impact factor
       >5019 (21)
       20-508 (9)
       5-2065 (71)
      Article type
       Original article54 (59)
       Research letter35 (38)
       Other (brief report or communication)3 (3)
      Study design
       Retrospective observational83 (90)
       RCT5 (5)
       Prospective observational4 (4)
      Study center
       Single-center51 (55)
       Multicenter39 (42)
       Unknown2 (2)
      Geographic area
       Asia61 (66)
       Europe16 (17)
       North/South America10 (11)
       Multicountry5 (5)
      Sample size
       20-10036 (39)
       100-100045 (49)
       >100011 (12)
      Critically ill population
       Subgroup64 (70)
       Full cohort28 (30)
      Critical illness categories
       Patients admitted to the ICU23 (25)
       Severe (Chinese guidelines)25 (27)
       Severe (American guidelines)3 (3)
       Organ injury or dysfunction23 (25)
       Patients who died of COVID-1918 (20)
      Research domain
       Clinical characteristics52 (57)
       Risk factors29 (32)
       Treatment11 (12)
      a COVID-19, coronavirus disease 2019; ICU, intensive care unit; RCT, randomized clinical trial.
      b Percentages may not total 100 because of rounding.

      Clinical Characteristics and Outcomes of Critically Ill Patients With COVID-19

      The main clinical characteristics and outcomes from 52 studies of critically ill patients with COVID-19 are summarized in Table 2 (not including laboratory findings). Among those who died, it appears that those in European countries
      • Inciardi R.M.
      • Adamo M.
      • Lupi L.
      • et al.
      Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.
      ,
      • Tomlins J.
      • Hamilton F.
      • Gunning S.
      • Sheehy C.
      • Moran E.
      • MacGowan A.
      Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the first UK cohort.
      were older than those in Asian countries.
      • Chen T.
      • Wu D.
      • Chen H.
      • et al.
      Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020;368:m1295].
      ,
      • Wang D.
      • Yin Y.
      • Hu C.
      • et al.
      Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.
      ,
      • Cao J.
      • Tu W.-J.
      • Cheng W.
      • et al.
      Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China].
      ,
      • Du Y.
      • Tu L.
      • Zhu P.
      • et al.
      Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study.
      ,
      • Ruan Q.
      • Yang K.
      • Wang W.
      • Jiang L.
      • Song J.
      Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China [published correction appears in Intensive Care Med. 2020;46(6):1294-1297].
      ,
      • Tu W.-J.
      • Cao J.
      • Yu L.
      • Hu X.
      • Liu Q.
      Clinicolaboratory study of 25 fatal cases of COVID-19 in Wuhan.
      Generally, the median/mean age of nonsurvivors was higher compared with survivors in Europe. The fatality rate of male patients was significantly higher than that of females in all studies. Males were more likely to have organ injuries, experience progression to severe status, and be admitted to the ICU in almost all the studies. Two US studies reported that race/ethnicity did not significantly differ between nonsevere and severe COVID-19 groups.
      • Goyal P.
      • Choi J.J.
      • Pinheiro L.C.
      • et al.
      Clinical characteristics of Covid-19 in New York City.
      ,
      • Pereira M.R.
      • Mohan S.
      • Cohen D.J.
      • et al.
      COVID-19 in solid organ transplant recipients: initial report from the US epicenter.
      Studies found that 21% to 84% of critically ill patients had development of neurologic symptoms including central nervous system symptoms.
      • Kandemirli S.G.
      • Dogan L.
      • Sarikaya Z.T.
      • et al.
      Brain MRI findings in patients in the intensive care unit with COVID-19 infection.
      ,
      • Helms J.
      • Kremer S.
      • Merdji H.
      • et al.
      Neurologic features in severe SARS-CoV-2 infection.
      ,
      • Mao L.
      • Jin H.
      • Wang M.
      • et al.
      Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.
      This population often had comorbidities, with 38% to 90% having at least one coexisting condition. The prevalence of chronic obstructive pulmonary disease (20% to 21%
      • Inciardi R.M.
      • Adamo M.
      • Lupi L.
      • et al.
      Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.
      ,
      • Tomlins J.
      • Hamilton F.
      • Gunning S.
      • Sheehy C.
      • Moran E.
      • MacGowan A.
      Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the first UK cohort.
      vs 2% to 5%
      • Wang D.
      • Yin Y.
      • Hu C.
      • et al.
      Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.
      ,
      • Du Y.
      • Tu L.
      • Zhu P.
      • et al.
      Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study.
      ,
      • Ruan Q.
      • Yang K.
      • Wang W.
      • Jiang L.
      • Song J.
      Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China [published correction appears in Intensive Care Med. 2020;46(6):1294-1297].
      ), diabetes (47% to 65%
      • Inciardi R.M.
      • Adamo M.
      • Lupi L.
      • et al.
      Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.
      ,
      • Tomlins J.
      • Hamilton F.
      • Gunning S.
      • Sheehy C.
      • Moran E.
      • MacGowan A.
      Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the first UK cohort.
      vs 18% to 35%
      • Chen T.
      • Wu D.
      • Chen H.
      • et al.
      Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020;368:m1295].
      • Wang D.
      • Yin Y.
      • Hu C.
      • et al.
      Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.
      • Deng G.
      • Yin M.
      • Chen X.
      • Zeng F.
      Clinical determinants for fatality of 44,672 patients with COVID-19.
      • Cao J.
      • Tu W.-J.
      • Cheng W.
      • et al.
      Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China].
      • Du Y.
      • Tu L.
      • Zhu P.
      • et al.
      Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study.
      ,
      • Ruan Q.
      • Yang K.
      • Wang W.
      • Jiang L.
      • Song J.
      Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China [published correction appears in Intensive Care Med. 2020;46(6):1294-1297].
      ), chronic kidney disease (30% to 53%
      • Inciardi R.M.
      • Adamo M.
      • Lupi L.
      • et al.
      Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.
      ,
      • Tomlins J.
      • Hamilton F.
      • Gunning S.
      • Sheehy C.
      • Moran E.
      • MacGowan A.
      Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the first UK cohort.
      vs 3% to 18%
      • Chen T.
      • Wu D.
      • Chen H.
      • et al.
      Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020;368:m1295].
      ,
      • Wang D.
      • Yin Y.
      • Hu C.
      • et al.
      Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.
      ,
      • Cao J.
      • Tu W.-J.
      • Cheng W.
      • et al.
      Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China].
      ,
      • Du Y.
      • Tu L.
      • Zhu P.
      • et al.
      Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study.
      ,
      • Ruan Q.
      • Yang K.
      • Wang W.
      • Jiang L.
      • Song J.
      Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China [published correction appears in Intensive Care Med. 2020;46(6):1294-1297].
      ), cancer (15% to 37%
      • Inciardi R.M.
      • Adamo M.
      • Lupi L.
      • et al.
      Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.
      ,
      • Tomlins J.
      • Hamilton F.
      • Gunning S.
      • Sheehy C.
      • Moran E.
      • MacGowan A.
      Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the first UK cohort.
      vs 2% to 7%
      • Chen T.
      • Wu D.
      • Chen H.
      • et al.
      Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020;368:m1295].
      ,
      • Deng G.
      • Yin M.
      • Chen X.
      • Zeng F.
      Clinical determinants for fatality of 44,672 patients with COVID-19.
      • Cao J.
      • Tu W.-J.
      • Cheng W.
      • et al.
      Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China].
      • Du Y.
      • Tu L.
      • Zhu P.
      • et al.
      Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study.
      ,
      • Ruan Q.
      • Yang K.
      • Wang W.
      • Jiang L.
      • Song J.
      Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China [published correction appears in Intensive Care Med. 2020;46(6):1294-1297].
      ), smoking (34%
      • Inciardi R.M.
      • Adamo M.
      • Lupi L.
      • et al.
      Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.
      ,
      • Tomlins J.
      • Hamilton F.
      • Gunning S.
      • Sheehy C.
      • Moran E.
      • MacGowan A.
      Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the first UK cohort.
      vs 8%
      • Chen T.
      • Wu D.
      • Chen H.
      • et al.
      Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020;368:m1295].
      ) among patients who died in European countries or the United States appears to be higher than in Asian countries. Obesity
      • Goyal P.
      • Choi J.J.
      • Pinheiro L.C.
      • et al.
      Clinical characteristics of Covid-19 in New York City.
      ,
      • Inciardi R.M.
      • Adamo M.
      • Lupi L.
      • et al.
      Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.
      and obstructive sleep apnea,
      • Arentz M.
      • Yim E.
      • Klaff L.
      • et al.
      Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.
      ,
      • Bhatraju P.K.
      • Ghassemieh B.J.
      • Nichols M.
      • et al.
      Covid-19 in critically ill patients in the Seattle region - case series.
      ,
      • Tomlins J.
      • Hamilton F.
      • Gunning S.
      • Sheehy C.
      • Moran E.
      • MacGowan A.
      Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the first UK cohort.
      which were seldom reported in Asian countries, are common among critically ill patients infected with SARS-CoV-2 in Western countries.
      Table 2Clinical Characteristics, Interventions, and Outcomes of Critically Ill Patients With COVID-19
      CharacteristicsAsian (30 studies)European and American (21 studies)
      Age range (y), median
       Overall49-71
      • Huang C.
      • Wang Y.
      • Li X.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020;395(10223):496].
      ,
      • Shen L.
      • Li S.
      • Zhu Y.
      • et al.
      Clinical and laboratory-derived parameters of 119 hospitalized patients with coronavirus disease 2019 in Xiangyang, Hubei Province, China.
      ,
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      ,
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020;8(4):e26].
      • Tang X.
      • Du R.-H.
      • Wang R.
      • et al.
      Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1.
      • Lee J.
      • Lee Y.H.
      • Chang H.-H.
      • et al.
      Comparison of short-term mortality between mechanically ventilated patients with COVID-19 and influenza in a setting of sustainable healthcare system.
      • Bhatraju P.K.
      • Ghassemieh B.J.
      • Nichols M.
      • et al.
      Covid-19 in critically ill patients in the Seattle region - case series.
      • Borba M.G.S.
      • Val F.F.A.
      • Sampaio V.S.
      • et al.
      CloroCovid-19 Team
      Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a randomized clinical trial.
      ,
      • Li J.
      • Wang X.
      • Chen J.
      • Zhang H.
      • Deng A.
      Association of renin-angiotensin system inhibitors with severity or risk of death in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19) infection in Wuhan, China.
      ,
      • Tian S.
      • Hu N.
      • Lou J.
      • et al.
      Characteristics of COVID-19 infection in Beijing.
      • Xu Y.-H.
      • Dong J.-H.
      • An W.-M.
      • et al.
      Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2.
      • Chen G.
      • Wu D.
      • Guo W.
      • et al.
      Clinical and immunological features of severe and moderate coronavirus disease 2019.
      • Ma J.
      • Yin J.
      • Qian Y.
      • Wu Y.
      Clinical characteristics and prognosis in cancer patients with COVID-19: a single center's retrospective study.
      • Pan L.
      • Mu M.
      • Yang P.
      • et al.
      Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study.
      • Zhou B.
      • She J.
      • Wang Y.
      • Ma X.
      The clinical characteristics of myocardial injury in severe and very severe patients with 2019 novel coronavirus disease.
      • Chen L.
      • Zhang B.
      • Ti M.-Y.-D.-L.N.-J.
      • Yang K.
      • Zou Y.
      • Zhang S.
      Clinical course of severe and critically ill patients with coronavirus disease 2019 (COVID-19): a comparative study.
      • Feng Y.
      • Ling Y.
      • Bai T.
      • et al.
      COVID-19 with different severities: a multicenter study of clinical features.
      ,
      • Qin C.
      • Zhou L.
      • Hu Z.
      • et al.
      Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China.
      ,
      • Xu B.
      • Fan C.-Y.
      • Wang A.-L.
      • et al.
      Suppressed T cell-mediated immunity in patients with COVID-19: a clinical retrospective study in Wuhan, China.
      ,
      • Zheng S.
      • Fan J.
      • Yu F.
      • et al.
      Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study.
      ,
      • Guan W.-J.
      • Ni Z.-Y.
      • Hu Y.
      • et al.
      Clinical characteristics of coronavirus disease 2019 in China.
      ,
      • Mao L.
      • Jin H.
      • Wang M.
      • et al.
      Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.
      ,
      • Guo T.
      • Fan Y.
      • Chen M.
      • et al.
      Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19).
      ,
      • Wang Z.
      • Yang B.
      • Li Q.
      • Wen L.
      • Zhang R.
      Clinical features of 69 cases with coronavirus disease 2019 in Wuhan, China.
      58-70
      • Grasselli G.
      • Zangrillo A.
      • Zanella A.
      • et al.
      COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy.
      • Kandemirli S.G.
      • Dogan L.
      • Sarikaya Z.T.
      • et al.
      Brain MRI findings in patients in the intensive care unit with COVID-19 infection.
      • Arentz M.
      • Yim E.
      • Klaff L.
      • et al.
      Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.
      • Myers L.C.
      • Parodi S.M.
      • Escobar G.J.
      • Liu V.X.
      Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.
      ,
      • Bhatraju P.K.
      • Ghassemieh B.J.
      • Nichols M.
      • et al.
      Covid-19 in critically ill patients in the Seattle region - case series.
      ,
      • Helms J.
      • Tacquard C.
      • Severac F.
      • et al.
      CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)
      High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study.
      ,
      • Cardoso F.S.
      • Pereira R.
      • Germano N.
      Liver injury in critically ill patients with COVID-19: a case series.
      ,
      • Helms J.
      • Kremer S.
      • Merdji H.
      • et al.
      Neurologic features in severe SARS-CoV-2 infection.
      ,
      • Ziehr D.R.
      • Alladina J.
      • Petri C.R.
      • et al.
      Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.
      ,
      • Criel M.
      • Falter M.
      • Jaeken J.
      • et al.
      Venous thromboembolism in SARS-CoV-2 patients: only a problem in ventilated ICU patients, or is there more to it?.
      ,
      • Goyal P.
      • Choi J.J.
      • Pinheiro L.C.
      • et al.
      Clinical characteristics of Covid-19 in New York City.
      ,
      • Bompard F.
      • Monnier H.
      • Saab I.
      • et al.
      Pulmonary embolism in patients with COVID-19 pneumonia.
      ,
      • Stefanini G.G.
      • Montorfano M.
      • Trabattoni D.
      • et al.
      ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes.
      ,
      • Pereira M.R.
      • Mohan S.
      • Cohen D.J.
      • et al.
      COVID-19 in solid organ transplant recipients: initial report from the US epicenter.
      ,
      • Grillet F.
      • Behr J.
      • Calame P.
      • Aubry S.
      • Delabrousse E.
      Acute pulmonary embolism associated with COVID-19 pneumonia detected with pulmonary CT angiography.
       Fatal cases66-73
      • Chen T.
      • Wu D.
      • Chen H.
      • et al.
      Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020;368:m1295].
      ,
      • Wang D.
      • Yin Y.
      • Hu C.
      • et al.
      Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.
      ,
      • Cao J.
      • Tu W.-J.
      • Cheng W.
      • et al.
      Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China].
      ,
      • Du Y.
      • Tu L.
      • Zhu P.
      • et al.
      Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study.
      ,
      • Ruan Q.
      • Yang K.
      • Wang W.
      • Jiang L.
      • Song J.
      Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China [published correction appears in Intensive Care Med. 2020;46(6):1294-1297].
      ,
      • Tu W.-J.
      • Cao J.
      • Yu L.
      • Hu X.
      • Liu Q.
      Clinicolaboratory study of 25 fatal cases of COVID-19 in Wuhan.
      72 (Italy)
      • Inciardi R.M.
      • Adamo M.
      • Lupi L.
      • et al.
      Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.
      ; 77 (UK)
      • Tomlins J.
      • Hamilton F.
      • Gunning S.
      • Sheehy C.
      • Moran E.
      • MacGowan A.
      Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the first UK cohort.
      Male
       Overall46%-91%
      • Huang C.
      • Wang Y.
      • Li X.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020;395(10223):496].
      ,
      • Shen L.
      • Li S.
      • Zhu Y.
      • et al.
      Clinical and laboratory-derived parameters of 119 hospitalized patients with coronavirus disease 2019 in Xiangyang, Hubei Province, China.
      ,
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      ,
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020;8(4):e26].
      • Tang X.
      • Du R.-H.
      • Wang R.
      • et al.
      Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1.
      • Lee J.
      • Lee Y.H.
      • Chang H.-H.
      • et al.
      Comparison of short-term mortality between mechanically ventilated patients with COVID-19 and influenza in a setting of sustainable healthcare system.
      ,
      • Li J.
      • Wang X.
      • Chen J.
      • Zhang H.
      • Deng A.
      Association of renin-angiotensin system inhibitors with severity or risk of death in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19) infection in Wuhan, China.
      ,
      • Tian S.
      • Hu N.
      • Lou J.
      • et al.
      Characteristics of COVID-19 infection in Beijing.
      • Xu Y.-H.
      • Dong J.-H.
      • An W.-M.
      • et al.
      Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2.
      • Chen G.
      • Wu D.
      • Guo W.
      • et al.
      Clinical and immunological features of severe and moderate coronavirus disease 2019.
      • Ma J.
      • Yin J.
      • Qian Y.
      • Wu Y.
      Clinical characteristics and prognosis in cancer patients with COVID-19: a single center's retrospective study.
      • Pan L.
      • Mu M.
      • Yang P.
      • et al.
      Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study.
      • Zhou B.
      • She J.
      • Wang Y.
      • Ma X.
      The clinical characteristics of myocardial injury in severe and very severe patients with 2019 novel coronavirus disease.
      • Chen L.
      • Zhang B.
      • Ti M.-Y.-D.-L.N.-J.
      • Yang K.
      • Zou Y.
      • Zhang S.
      Clinical course of severe and critically ill patients with coronavirus disease 2019 (COVID-19): a comparative study.
      • Feng Y.
      • Ling Y.
      • Bai T.
      • et al.
      COVID-19 with different severities: a multicenter study of clinical features.
      ,
      • Qin C.
      • Zhou L.
      • Hu Z.
      • et al.
      Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China.
      ,
      • Xu B.
      • Fan C.-Y.
      • Wang A.-L.
      • et al.
      Suppressed T cell-mediated immunity in patients with COVID-19: a clinical retrospective study in Wuhan, China.
      ,
      • Zheng S.
      • Fan J.
      • Yu F.
      • et al.
      Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study.
      ,
      • Guan W.-J.
      • Ni Z.-Y.
      • Hu Y.
      • et al.
      Clinical characteristics of coronavirus disease 2019 in China.
      ,
      • Mao L.
      • Jin H.
      • Wang M.
      • et al.
      Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.
      ,
      • Guo T.
      • Fan Y.
      • Chen M.
      • et al.
      Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19).
      ,
      • Wang Z.
      • Yang B.
      • Li Q.
      • Wen L.
      • Zhang R.
      Clinical features of 69 cases with coronavirus disease 2019 in Wuhan, China.
      52%-90%
      • Grasselli G.
      • Zangrillo A.
      • Zanella A.
      • et al.
      COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy.
      • Kandemirli S.G.
      • Dogan L.
      • Sarikaya Z.T.
      • et al.
      Brain MRI findings in patients in the intensive care unit with COVID-19 infection.
      • Arentz M.
      • Yim E.
      • Klaff L.
      • et al.
      Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.
      • Myers L.C.
      • Parodi S.M.
      • Escobar G.J.
      • Liu V.X.
      Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.
      ,
      • Bhatraju P.K.
      • Ghassemieh B.J.
      • Nichols M.
      • et al.
      Covid-19 in critically ill patients in the Seattle region - case series.
      ,
      • Helms J.
      • Tacquard C.
      • Severac F.
      • et al.
      CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)
      High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study.
      ,
      • Cardoso F.S.
      • Pereira R.
      • Germano N.
      Liver injury in critically ill patients with COVID-19: a case series.
      ,
      • Ziehr D.R.
      • Alladina J.
      • Petri C.R.
      • et al.
      Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.
      ,
      • Criel M.
      • Falter M.
      • Jaeken J.
      • et al.
      Venous thromboembolism in SARS-CoV-2 patients: only a problem in ventilated ICU patients, or is there more to it?.
      ,
      • Colaneri M.
      • Sacchi P.
      • Zuccaro V.
      • et al.
      COVID19 IRCCS San Matteo Pavia Task Force
      Clinical characteristics of coronavirus disease (COVID-19) early findings from a teaching hospital in Pavia, North Italy, 21 to 28 February 2020.
      ,
      • Pereira M.R.
      • Mohan S.
      • Cohen D.J.
      • et al.
      COVID-19 in solid organ transplant recipients: initial report from the US epicenter.
      ,
      • Grillet F.
      • Behr J.
      • Calame P.
      • Aubry S.
      • Delabrousse E.
      Acute pulmonary embolism associated with COVID-19 pneumonia detected with pulmonary CT angiography.
       Fatal cases64%-85%
      • Li W.
      • Zhang J.
      • Xiao S.
      • Sun L.
      Characteristics of deaths amongst health workers in China during the outbreak of COVID-19 infection.
      ,
      • Chen T.
      • Wu D.
      • Chen H.
      • et al.
      Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020;368:m1295].
      • Wang D.
      • Yin Y.
      • Hu C.
      • et al.
      Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.
      • Deng G.
      • Yin M.
      • Chen X.
      • Zeng F.
      Clinical determinants for fatality of 44,672 patients with COVID-19.
      • Cao J.
      • Tu W.-J.
      • Cheng W.
      • et al.
      Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China].
      • Du Y.
      • Tu L.
      • Zhu P.
      • et al.
      Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study.
      ,
      • Ruan Q.
      • Yang K.
      • Wang W.
      • Jiang L.
      • Song J.
      Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China [published correction appears in Intensive Care Med. 2020;46(6):1294-1297].
      ,
      • Tu W.-J.
      • Cao J.
      • Yu L.
      • Hu X.
      • Liu Q.
      Clinicolaboratory study of 25 fatal cases of COVID-19 in Wuhan.
      90% (Italy)
      • Inciardi R.M.
      • Adamo M.
      • Lupi L.
      • et al.
      Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.
      ; 60% (UK)
      • Tomlins J.
      • Hamilton F.
      • Gunning S.
      • Sheehy C.
      • Moran E.
      • MacGowan A.
      Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the first UK cohort.
      Symptoms
       CommonFever, 46%-100%; cough, 22%-85%; dyspnea, 30%-100%; fatigue, 10%-100%; myalgia, 2%-50%; sputum, 20%-61%; diarrhea, 6%-31%
      • Huang C.
      • Wang Y.
      • Li X.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020;395(10223):496].
      ,
      • Shen L.
      • Li S.
      • Zhu Y.
      • et al.
      Clinical and laboratory-derived parameters of 119 hospitalized patients with coronavirus disease 2019 in Xiangyang, Hubei Province, China.
      ,
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      ,
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020;8(4):e26].
      • Tang X.
      • Du R.-H.
      • Wang R.
      • et al.
      Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1.
      • Lee J.
      • Lee Y.H.
      • Chang H.-H.
      • et al.
      Comparison of short-term mortality between mechanically ventilated patients with COVID-19 and influenza in a setting of sustainable healthcare system.
      ,
      • Tian S.
      • Hu N.
      • Lou J.
      • et al.
      Characteristics of COVID-19 infection in Beijing.
      ,
      • Chen G.
      • Wu D.
      • Guo W.
      • et al.
      Clinical and immunological features of severe and moderate coronavirus disease 2019.
      ,
      • Pan L.
      • Mu M.
      • Yang P.
      • et al.
      Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study.
      ,
      • Chen L.
      • Zhang B.
      • Ti M.-Y.-D.-L.N.-J.
      • Yang K.
      • Zou Y.
      • Zhang S.
      Clinical course of severe and critically ill patients with coronavirus disease 2019 (COVID-19): a comparative study.
      ,
      • Feng Y.
      • Ling Y.
      • Bai T.
      • et al.
      COVID-19 with different severities: a multicenter study of clinical features.
      ,
      • Qin C.
      • Zhou L.
      • Hu Z.
      • et al.
      Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China.
      ,
      • Xu B.
      • Fan C.-Y.
      • Wang A.-L.
      • et al.
      Suppressed T cell-mediated immunity in patients with COVID-19: a clinical retrospective study in Wuhan, China.
      ,
      • Zheng S.
      • Fan J.
      • Yu F.
      • et al.
      Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study.
      ,
      • Guan W.-J.
      • Ni Z.-Y.
      • Hu Y.
      • et al.
      Clinical characteristics of coronavirus disease 2019 in China.
      ,
      • Mao L.
      • Jin H.
      • Wang M.
      • et al.
      Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.
      ,
      • Wang Z.
      • Yang B.
      • Li Q.
      • Wen L.
      • Zhang R.
      Clinical features of 69 cases with coronavirus disease 2019 in Wuhan, China.
      ,
      • Chen T.
      • Wu D.
      • Chen H.
      • et al.
      Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study [published correction appears in BMJ. 2020;368:m1295].
      ,
      • Wang D.
      • Yin Y.
      • Hu C.
      • et al.
      Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.
      ,
      • Cao J.
      • Tu W.-J.
      • Cheng W.
      • et al.
      Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China].
      ,
      • Du Y.
      • Tu L.
      • Zhu P.
      • et al.
      Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study.
      ,
      • Ruan Q.
      • Yang K.
      • Wang W.
      • Jiang L.
      • Song J.
      Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China [published correction appears in Intensive Care Med. 2020;46(6):1294-1297].
      Fever, 35%-100%; cough, 30%-88%; dyspnea/SOB, 24%-91%; fatigue, 19%-67%; myalgia, 5%-55%; sputum, 42%; diarrhea, 12%-28%
      • Arentz M.
      • Yim E.
      • Klaff L.
      • et al.
      Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.
      ,
      • Myers L.C.
      • Parodi S.M.
      • Escobar G.J.
      • Liu V.X.
      Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.
      ,
      • Bhatraju P.K.
      • Ghassemieh B.J.
      • Nichols M.
      • et al.
      Covid-19 in critically ill patients in the Seattle region - case series.
      ,
      • Ziehr D.R.
      • Alladina J.
      • Petri C.R.
      • et al.
      Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.
      ,
      • Colaneri M.
      • Sacchi P.
      • Zuccaro V.
      • et al.
      COVID19 IRCCS San Matteo Pavia Task Force
      Clinical characteristics of coronavirus disease (COVID-19) early findings from a teaching hospital in Pavia, North Italy, 21 to 28 February 2020.
      ,
      • Goyal P.
      • Choi J.J.
      • Pinheiro L.C.
      • et al.
      Clinical characteristics of Covid-19 in New York City.
      ,
      • Pereira M.R.
      • Mohan S.
      • Cohen D.J.
      • et al.
      COVID-19 in solid organ transplant recipients: initial report from the US epicenter.
      ,
      • Tomlins J.
      • Hamilton F.
      • Gunning S.
      • Sheehy C.
      • Moran E.
      • MacGowan A.
      Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the first UK cohort.
       Neurologic46% (China)
      • Mao L.
      • Jin H.
      • Wang M.
      • et al.
      Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.
      84% (France)
      • Helms J.
      • Kremer S.
      • Merdji H.
      • et al.
      Neurologic features in severe SARS-CoV-2 infection.
      ; 21% (Turkey)
      • Kandemirli S.G.
      • Dogan L.
      • Sarikaya Z.T.
      • et al.
      Brain MRI findings in patients in the intensive care unit with COVID-19 infection.
      Comorbidities
       OverallAny: 38%-85%
      • Huang C.
      • Wang Y.
      • Li X.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020;395(10223):496].
      ,
      • Shen L.
      • Li S.
      • Zhu Y.
      • et al.
      Clinical and laboratory-derived parameters of 119 hospitalized patients with coronavirus disease 2019 in Xiangyang, Hubei Province, China.
      ,
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      ,
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020;8(4):e26].
      • Tang X.
      • Du R.-H.
      • Wang R.
      • et al.
      Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1.
      • Lee J.
      • Lee Y.H.
      • Chang H.-H.
      • et al.
      Comparison of short-term mortality between mechanically ventilated patients with COVID-19 and influenza in a setting of sustainable healthcare system.
      ,
      • Chen G.
      • Wu D.
      • Guo W.
      • et al.
      Clinical and immunological features of severe and moderate coronavirus disease 2019.
      ,
      • Chen L.
      • Zhang B.
      • Ti M.-Y.-D.-L.N.-J.
      • Yang K.
      • Zou Y.
      • Zhang S.
      Clinical course of severe and critically ill patients with coronavirus disease 2019 (COVID-19): a comparative study.
      ,
      • Feng Y.
      • Ling Y.
      • Bai T.
      • et al.
      COVID-19 with different severities: a multicenter study of clinical features.
      ,
      • Qin C.
      • Zhou L.
      • Hu Z.
      • et al.
      Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China.
      ,
      • Guan W.-J.
      • Ni Z.-Y.
      • Hu Y.
      • et al.
      Clinical characteristics of coronavirus disease 2019 in China.
      ,
      • Mao L.
      • Jin H.
      • Wang M.
      • et al.
      Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.


      Respiratory, 1%-8%
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020;8(4):e26].
      ,
      • Tang X.
      • Du R.-H.
      • Wang R.
      • et al.
      Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1.
      (COPD, 8%
      • Huang C.
      • Wang Y.
      • Li X.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020;395(10223):496].
      ,
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      ); diabetes, 8%-27%
      • Huang C.
      • Wang Y.
      • Li X.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020;395(10223):496].
      ,
      • Shen L.
      • Li S.
      • Zhu Y.
      • et al.
      Clinical and laboratory-derived parameters of 119 hospitalized patients with coronavirus disease 2019 in Xiangyang, Hubei Province, China.
      ,
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      ,
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020;8(4):e26].
      ,
      • Tang X.
      • Du R.-H.
      • Wang R.
      • et al.
      Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1.
      ; hypertension, 15%-65%
      • Huang C.
      • Wang Y.
      • Li X.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020;395(10223):496].
      ,
      • Shen L.
      • Li S.
      • Zhu Y.
      • et al.
      Clinical and laboratory-derived parameters of 119 hospitalized patients with coronavirus disease 2019 in Xiangyang, Hubei Province, China.
      ,
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      ,
      • Tang X.
      • Du R.-H.
      • Wang R.
      • et al.
      Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1.
      ; cardiovascular, 10%-32%
      • Huang C.
      • Wang Y.
      • Li X.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020;395(10223):496].
      ,
      • Shen L.
      • Li S.
      • Zhu Y.
      • et al.
      Clinical and laboratory-derived parameters of 119 hospitalized patients with coronavirus disease 2019 in Xiangyang, Hubei Province, China.
      ,
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      ,
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020;8(4):e26].
      ,
      • Tang X.
      • Du R.-H.
      • Wang R.
      • et al.
      Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1.
      ; neurologic, 14%-17%
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      ,
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020;8(4):e26].
      ; CKD, 4%-6%
      • Shen L.
      • Li S.
      • Zhu Y.
      • et al.
      Clinical and laboratory-derived parameters of 119 hospitalized patients with coronavirus disease 2019 in Xiangyang, Hubei Province, China.
      ,
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      ,
      • Tang X.
      • Du R.-H.
      • Wang R.
      • et al.
      Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1.
      ; cancer, 4%-11%
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
      ,
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020;8(4):e26].
      ;

      smoking, 4%-50%
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020;8(4):e26].
      • Tang X.
      • Du R.-H.
      • Wang R.
      • et al.
      Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1.
      • Lee J.
      • Lee Y.H.
      • Chang H.-H.
      • et al.
      Comparison of short-term mortality between mechanically ventilated patients with COVID-19 and influenza in a setting of sustainable healthcare system.
      Any: 68%-86%
      • Grasselli G.
      • Zangrillo A.
      • Zanella A.
      • et al.
      COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy.
      ,
      • Arentz M.
      • Yim E.
      • Klaff L.
      • et al.
      Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.
      ,
      • Colaneri M.
      • Sacchi P.
      • Zuccaro V.
      • et al.
      COVID19 IRCCS San Matteo Pavia Task Force
      Clinical characteristics of coronavirus disease (COVID-19) early findings from a teaching hospital in Pavia, North Italy, 21 to 28 February 2020.


      Respiratory, 7%-18%
      • Myers L.C.
      • Parodi S.M.
      • Escobar G.J.
      • Liu V.X.
      Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.
      ,
      • Bhatraju P.K.
      • Ghassemieh B.J.
      • Nichols M.
      • et al.
      Covid-19 in critically ill patients in the Seattle region - case series.
      ,
      • Helms J.
      • Tacquard C.
      • Severac F.
      • et al.
      CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)
      High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study.
      ,
      • Ziehr D.R.
      • Alladina J.
      • Petri C.R.
      • et al.
      Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.
      (COPD, 4%-33%
      • Grasselli G.
      • Zangrillo A.
      • Zanella A.
      • et al.
      COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy.
      ,
      • Arentz M.
      • Yim E.
      • Klaff L.
      • et al.
      Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.
      ); diabetes, 17%-58%
      • Grasselli G.
      • Zangrillo A.
      • Zanella A.
      • et al.
      COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy.
      ,
      • Arentz M.
      • Yim E.
      • Klaff L.
      • et al.
      Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.
      ,
      • Myers L.C.
      • Parodi S.M.
      • Escobar G.J.
      • Liu V.X.
      Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.
      ,
      • Bhatraju P.K.
      • Ghassemieh B.J.
      • Nichols M.
      • et al.
      Covid-19 in critically ill patients in the Seattle region - case series.
      ,
      • Helms J.
      • Tacquard C.
      • Severac F.
      • et al.
      CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)
      High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study.
      ,
      • Ziehr D.R.
      • Alladina J.
      • Petri C.R.
      • et al.
      Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.
      ,
      • Criel M.
      • Falter M.
      • Jaeken J.
      • et al.
      Venous thromboembolism in SARS-CoV-2 patients: only a problem in ventilated ICU patients, or is there more to it?.
      ; hypertension, 33%-51%
      • Grasselli G.
      • Zangrillo A.
      • Zanella A.
      • et al.
      COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy.
      ,
      • Myers L.C.
      • Parodi S.M.
      • Escobar G.J.
      • Liu V.X.
      Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.
      ,
      • Ziehr D.R.
      • Alladina J.
      • Petri C.R.
      • et al.
      Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.
      ,
      • Criel M.
      • Falter M.
      • Jaeken J.
      • et al.
      Venous thromboembolism in SARS-CoV-2 patients: only a problem in ventilated ICU patients, or is there more to it?.
      ; cardiovascular, 4%-48%
      • Grasselli G.
      • Zangrillo A.
      • Zanella A.
      • et al.
      COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy.
      ,
      • Myers L.C.
      • Parodi S.M.
      • Escobar G.J.
      • Liu V.X.
      Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.
      ,
      • Helms J.
      • Tacquard C.
      • Severac F.
      • et al.
      CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)
      High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study.
      ,
      • Ziehr D.R.
      • Alladina J.
      • Petri C.R.
      • et al.
      Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.
      ; CKD, 3%-48%
      • Grasselli G.
      • Zangrillo A.
      • Zanella A.
      • et al.
      COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy.
      ,
      • Arentz M.
      • Yim E.
      • Klaff L.
      • et al.
      Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.
      ,
      • Myers L.C.
      • Parodi S.M.
      • Escobar G.J.
      • Liu V.X.
      Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.
      ,
      • Bhatraju P.K.
      • Ghassemieh B.J.
      • Nichols M.
      • et al.
      Covid-19 in critically ill patients in the Seattle region - case series.
      ,
      • Helms J.
      • Tacquard C.
      • Severac F.
      • et al.
      CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)
      High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study.
      ,
      • Ziehr D.R.
      • Alladina J.
      • Petri C.R.
      • et al.
      Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.
      ; cancer, 5%-8%
      • Grasselli G.
      • Zangrillo A.
      • Zanella A.
      • et al.
      COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy.
      ,
      • Myers L.C.
      • Parodi S.M.
      • Escobar G.J.
      • Liu V.X.
      Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.
      ,
      • Helms J.
      • Tacquard C.
      • Severac F.
      • et al.
      CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)
      High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study.
      ,
      • Ziehr D.R.
      • Alladina J.
      • Petri C.R.
      • et al.
      Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.
      <