A study conducted at Zhongnan Hospital of Wuhan University analyzed 155 patients with confirmed COVID-19 pneumonia, dividing them into general and refractory groups based on clinical and radiological remission within 10 days of hospitalization. Refractory patients showed significant differences in clinical characteristics compared to general patients. Refractory patients were older, more likely to be male, had more underlying comorbidities, lower fever incidence, higher maximum temperature among fever cases, higher incidence of breath shortness and anorexia, and more severe disease on admission. They also had higher levels of neutrophils, AST, LDH, and CRP, and lower levels of platelets and albumin. Refractory patients were more likely to require oxygen, mechanical ventilation, expectorants, and adjunctive treatments like corticosteroids, antivirals, and immune enhancers. Multivariate analysis identified male sex, anorexia on admission, and absence of fever as risk factors for refractory COVID-19, while fever was a protective factor. Refractory patients had higher levels of LDH and CRP, indicating more severe inflammation. The study highlights that nearly 50% of patients did not achieve clinical and radiological remission within 10 days, with male patients and those without fever on admission being more likely to have poor outcomes. The study also notes that the absence of fever does not rule out COVID-19, and that refractory patients required more intensive treatment. Limitations include potential selection bias and the study being based on a single center. The findings emphasize the importance of early identification and intervention for refractory cases to improve outcomes.A study conducted at Zhongnan Hospital of Wuhan University analyzed 155 patients with confirmed COVID-19 pneumonia, dividing them into general and refractory groups based on clinical and radiological remission within 10 days of hospitalization. Refractory patients showed significant differences in clinical characteristics compared to general patients. Refractory patients were older, more likely to be male, had more underlying comorbidities, lower fever incidence, higher maximum temperature among fever cases, higher incidence of breath shortness and anorexia, and more severe disease on admission. They also had higher levels of neutrophils, AST, LDH, and CRP, and lower levels of platelets and albumin. Refractory patients were more likely to require oxygen, mechanical ventilation, expectorants, and adjunctive treatments like corticosteroids, antivirals, and immune enhancers. Multivariate analysis identified male sex, anorexia on admission, and absence of fever as risk factors for refractory COVID-19, while fever was a protective factor. Refractory patients had higher levels of LDH and CRP, indicating more severe inflammation. The study highlights that nearly 50% of patients did not achieve clinical and radiological remission within 10 days, with male patients and those without fever on admission being more likely to have poor outcomes. The study also notes that the absence of fever does not rule out COVID-19, and that refractory patients required more intensive treatment. Limitations include potential selection bias and the study being based on a single center. The findings emphasize the importance of early identification and intervention for refractory cases to improve outcomes.