This study investigates the clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. The research included 155 consecutive patients with confirmed COVID-19 admitted to Zhongnan Hospital of Wuhan University from January 1st to February 5th. Patients were divided into general and refractory groups based on clinical efficacy after hospitalization. Refractory patients, who accounted for nearly 50% of the total, showed significant differences in age, gender, comorbidities, fever status, respiratory symptoms, laboratory findings, and treatment requirements compared to general patients. Key findings include older age, male sex, more underlying comorbidities, lower fever incidence, higher levels of maximum temperature among fever cases, higher incidence of breath shortness and anorexia, severer disease assessment on admission, and higher levels of neutrophils, AST, LDH, and CRP. Refractory patients were more likely to receive oxygen, mechanical ventilation, expectorant, and adjunctive treatments such as corticosteroids, antiviral drugs, and immune enhancers. Multivariate analysis identified male sex and anorexia on admission as risk factors for disease refractoriness, while fever on admission was a protective factor. The study highlights the need for early identification and intervention in refractory cases to improve outcomes and reduce mortality.This study investigates the clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. The research included 155 consecutive patients with confirmed COVID-19 admitted to Zhongnan Hospital of Wuhan University from January 1st to February 5th. Patients were divided into general and refractory groups based on clinical efficacy after hospitalization. Refractory patients, who accounted for nearly 50% of the total, showed significant differences in age, gender, comorbidities, fever status, respiratory symptoms, laboratory findings, and treatment requirements compared to general patients. Key findings include older age, male sex, more underlying comorbidities, lower fever incidence, higher levels of maximum temperature among fever cases, higher incidence of breath shortness and anorexia, severer disease assessment on admission, and higher levels of neutrophils, AST, LDH, and CRP. Refractory patients were more likely to receive oxygen, mechanical ventilation, expectorant, and adjunctive treatments such as corticosteroids, antiviral drugs, and immune enhancers. Multivariate analysis identified male sex and anorexia on admission as risk factors for disease refractoriness, while fever on admission was a protective factor. The study highlights the need for early identification and intervention in refractory cases to improve outcomes and reduce mortality.