Objective To investigate the clinical features of 13 fatal cases of corona virus disease 2019 (COVID-19). Methods The clinical data of 13 patients who died of COVID-19 in Central Theater General Hospital, China, between January 4, 2020, and February 24, 2020, were analyzed retrospectively . The data reviewed included clinical manifestations, laboratory test results, radiographic features and dinical treatment plan . The cellular immune function, the expression of inflammatory factors, and lactate level in deceased patients at different stages of the disease were analyzed . Results Of those who died, the patients consisted of 10 men and 3 women . The age of those who died was (74±19) years, and 10 (76.9 %) patients were over 70 years old . For the patients who died , 9 presented with underlying diseases , 6 (46.2 %) of whom had more than 2 diseases . On admission, the chest computed tomography (CT) for 8 patients (61.5 %) mainly showed multiple patchy ground-glass opacities . When the disease progressed, the ground-glass opacities rapidly developed into diffuse lesions in both lungs . The lymphocyte and CD3+, CD4+, and CD8+ T lymphocyte counts in the peripheral blood of 13 patients were significantly lower than normal levels and decreased more substantially during the disease course based on the levels when admitted (P <0.01). Additionally, the interleukin (IL) -6, D-dimer, C-reactive protein (CRP), lactic acid levels gradually increased, and most peaked before death . The cause of death for most patients was acute respiratory distress syndrome (ARDS) with type I respiratory failure . Three patients eventually developed multiorgan deficiency syndrome (MODS). Conclusions The risk factors of death for COVID-19 patients included older men, more underlying diseases, poor cellular immune function and over-expression of inflammatory factors . The main cause of death in patients with COVID-19 was ARDS, which led to respiratory failure and MODS.