lancet-header
Preprints with The Lancet is part of SSRN´s First Look, a place where journals and other research experts identify content of interest prior to publication. These preprint papers are not peer-reviewed and are posted here as part of a 12-month trial. Authors have either opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet, or submitted directly via SSRN. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. These papers should not be used for clinical decision making or reporting of research to a lay audience without indicating that this is preliminary research that has not been peer-reviewed. For more information see the Comment published in The Lancet, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com

The Treatment and Outcomes of Patients with COVID-19 in Hubei, China: A Multi-Centered, Retrospective, Observational Study

17 Pages Posted: 3 Mar 2020

See all articles by Jin Shang

Jin Shang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

Ronghui Du

Wuhan Respiratory Hospital - Department of Respiratory Medicine

Qiaofa Lu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory Medicine

Jianhong Wu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Gastrointestinal Surgery

Shabei Xu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Neurology

Zhenghua Ke

Hubei Polytechnic University - Edong Healthcare Group

Zhifang Cai

Wuhan Hankou Hospital - Department of Respiratory Diseases

Yiya Gu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

Qian Huang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

Yuan Zhan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

Jie Yang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory Medicine

Yumei Liu

Wuhan Hankou Hospital - Department of Respiratory Diseases

Yi Hu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

Haiying Zhang

Hubei Zhongshan Hospital - Department of Respiratory Medicine

Huxiang Huang

Huanggang Central Hospital - Department of Respiratory Medicine

Zhibin Xie

Huanggang Central Hospital - Department of Respiratory Medicine

Xin Li

China Resource and Wisco General Hospital - Department of Respiratory and Critical Care Medicine

Weihua Hu

Jingzhou Central Hospital - Department of Respiratory Medicine

Jianhua Gong

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory Medicine

Wenbing Ke

Yangtze University - Department of Respiratory and Critical Care Medicine

Zhilin Shao

Hubei Polytechnic University - Department of Hepatology

Zheng Liu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Otolaryngology-Head and Neck Surgery

Jungang Xie

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Critical Care Medicine

More...

Abstract

Background: Since December 2019, COVID-19 has emerged in Wuhan, China and spread rapidly throughout China. So far, there is still no explicit therapeutic regimen or specific drugs.

Methods: In this retrospective, multi-center study, we extracted the clinical data on 416 cases of COVID-19 with definite outcome from 14 hospitals in Hubei province, and evaluated the clinical characteristics and treatment regimens. Outcomes were followed up until Feb 17, 2020.

Finding: Fifty-one of 416 patients had died. Dead patients had a higher median age of 67·0 (IQR61·0-77·0), a higher percentage of males (31[61%]), and a higher prevalence of comorbidities (41[80%]) than survivors (discharged). More obvious abnormalities in laboratory tests had been found in dead patients. 91% (380/416) patients were given anti-viral therapy. The proportions of corticosteroid therapy (43[84%], γ-globulin (34[67%]) and invasive ventilation (12[24%]) increased significantly for deaths. For survivors who using corticosteroids had a prolonged hospitalization (common type: 12·0[IQR9·0-16·0] vs 10·0[IQR8·0-13·0]); severe/critical type: 14·0[IQR 10·0-18·0] vs 11·0[IQR 9·0-13·0]). Lymphocyte count recovered significantly after corticosteroid therapy in survivors (common type: from 0·9×109/L[IQR0·7-1·3] to 1·6×109/L[IQR1·3-1·7]; severe/critical type: from 0·9×109/L[IQR0·6-1·2] to 1·5×109/L[IQR1·2~2·0]), but not in dead patients (from 0·7× 109/L[IQR0·4-0·9] to 0·4× 109/L[IQR0·3-0·6]).

Interpretation: The treatment approaches and responses to treatment were different in COVID-19 patients with different outcomes. Anti-viral drugs and antibiotics have been widely used in the treatment of patients with COVID-19. Corticosteroid therapy, γ-globulin and invasive ventilation were more frequently used in death group. The patients with lower lymphocyte counts were more likely to be given corticosteroids. After corticosteroid therapy, lymphocytes of survivors revived and a longer hospitalization was observed, which was more likely to be the severity of disease. However, for death patients, lymphocytes remained unchanged after corticosteroid treatment. The recovery of lymphocyte counts and temperature after corticosteroid treatment may be used as predictors of prognosis of patients with COVID-19.

Funding Statement: Supported by the National Natural Science Foundation of China (No. 81973986 and 81570033).

Declaration of Interests: The authors declare that there is no conflict of interest regarding the publication of this paper.

Ethics Approval Statement: This study was approved by the ethics committee of respective hospitals and oral or written informed consent was obtained from all patients involved.

Keywords: COVID-19; treatment; outcome; corticosteroid; lymphocyte

Suggested Citation

Shang, Jin and Du, Ronghui and Lu, Qiaofa and Wu, Jianhong and Xu, Shabei and Ke, Zhenghua and Cai, Zhifang and Gu, Yiya and Huang, Qian and Zhan, Yuan and Yang, Jie and Liu, Yumei and Hu, Yi and Zhang, Haiying and Huang, Huxiang and Xie, Zhibin and Li, Xin and Hu, Weihua and Gong, Jianhua and Ke, Wenbing and Shao, Zhilin and Liu, Zheng and Xie, Jungang, The Treatment and Outcomes of Patients with COVID-19 in Hubei, China: A Multi-Centered, Retrospective, Observational Study (2/26/2020). Available at SSRN: https://ssrn.com/abstract=3546060 or http://dx.doi.org/10.2139/ssrn.3546060

Jin Shang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

China

Ronghui Du

Wuhan Respiratory Hospital - Department of Respiratory Medicine

China

Qiaofa Lu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory Medicine

Wuhan
China

Jianhong Wu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Gastrointestinal Surgery

Wuhan
China

Shabei Xu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Neurology

China

Zhenghua Ke

Hubei Polytechnic University - Edong Healthcare Group

Hubei
China

Zhifang Cai

Wuhan Hankou Hospital - Department of Respiratory Diseases

China

Yiya Gu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

China

Qian Huang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

China

Yuan Zhan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

China

Jie Yang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory Medicine

Wuhan
China

Yumei Liu

Wuhan Hankou Hospital - Department of Respiratory Diseases

China

Yi Hu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

Wuhan
China

Haiying Zhang

Hubei Zhongshan Hospital - Department of Respiratory Medicine

Wuhan
China

Huxiang Huang

Huanggang Central Hospital - Department of Respiratory Medicine

Huanggang
China

Zhibin Xie

Huanggang Central Hospital - Department of Respiratory Medicine

Huanggang
China

Xin Li

China Resource and Wisco General Hospital - Department of Respiratory and Critical Care Medicine

Wuhan
China

Weihua Hu

Jingzhou Central Hospital - Department of Respiratory Medicine

China

Jianhua Gong

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory Medicine

China

Wenbing Ke

Yangtze University - Department of Respiratory and Critical Care Medicine

Jingzhou
China

Zhilin Shao

Hubei Polytechnic University - Department of Hepatology

Huangshi
China

Zheng Liu (Contact Author)

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Otolaryngology-Head and Neck Surgery ( email )

Wuhan, 430030
China

Jungang Xie

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Critical Care Medicine ( email )

Wuhan
China

Click here to go to TheLancet.com

Paper statistics

Abstract Views
899
Downloads
263