The Treatment and Outcomes of Patients with COVID-19 in Hubei, China: A Multi-Centered, Retrospective, Observational Study
17 Pages Posted: 3 Mar 2020More...
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
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