Combined Interventions for Severe Novel Coronavirus Disease (COVID-19): Experience from 350 Patients

Ting Guo; Qinxue Shen; Zhiguo Zhou; Jinhua Li; Wei Guo; Wenlong He; Yunnian Wang; Zhi Xiang; Peng Huang; Nanyang Zeng; Qingwu Qin; Ping Chen; Hong Luo; Hong Peng

doi:10.2147/IDR.S279255

Combined Interventions for Severe Novel Coronavirus Disease (COVID-19): Experience from 350 Patients

Infect Drug Resist. 2020 Oct 30:13:3907-3918. doi: 10.2147/IDR.S279255. eCollection 2020.

Authors

Ting Guo^#^{1

2

3}, Qinxue Shen^#^{1

2

3}, Zhiguo Zhou⁴, Jinhua Li^{1

2

3}, Wei Guo^{1

2

3}, Wenlong He^{1

2

3}, Yunnian Wang⁵, Zhi Xiang⁶, Peng Huang⁷, Nanyang Zeng⁸, Qingwu Qin^{1

2

3}, Ping Chen^{1

2

3}, Hong Luo^{1

2

3}, Hong Peng^{1

2

3}

Affiliations

¹ Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan, People's Republic of China.
² Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.
³ The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China.
⁴ Department of Respiratory and Critical Care Medicine, The First Hospital of Changsha, Changsha, Hunan, People's Republic of China.
⁵ Department of Respiratory and Critical Care Medicine, The Traditional Chinese Medicine Hospital of Liling, Zhuzhou, Hunan, People's Republic of China.
⁶ Department of Respiratory and Critical Care Medicine, The First People's Hospital of Huaihua, Huaihua, Hunan, People's Republic of China.
⁷ Department of Respiratory and Critical Care Medicine, The Central Hospital of Zhuzhou, Zhuzhou, Hunan, People's Republic of China.
⁸ Department of Infectious Disease, The Lvkou People's Hospital of Zhuzhou, Zhuzhou, Hunan, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: To summarize the clinical features and effective therapy of severe COVID-19 patients.

Patients and methods: In this retrospective, multicenter study, the medical records of COVID-19 patients in Hunan, from January 21, 2020 to February 19, 2020 were reviewed.

Results: Of the 350 COVID-19 patients, 13.7% were severe cases. On admission, compared with non-severe patients, more severe patients had a neutrophil/lymphocyte ratio > 3 (58.3% vs 33.8%, P=0.001), D-dimer > 1 mg/L (41.7% vs 13.6%, P<0.0001), higher level of CRP (39.1 mg/L, IQR18.1-75.9 vs 13.4 mg/L, IQR5.0-32.8, P<0.0001), and multiple pneumonia on CT (77.1% vs 18.2%, P<0.0001). All severe patients received oxygen support. 95.8% of them received antivirals, and the most frequent therapy was lopinavir and ritonavir plus human interferon-α2b. Moxifloxacin was used in 70.8% severe patients. The total dosage of methylprednisolone sodium succinate was 640 mg (IQR 360-960) in severe patients, and the duration of use was 8.5 days (IQR 6.8-11.3). The total dosage of immunoglobulin was 80 g (IQR, 60-140) in severe patients, and the duration was 8.0 days (IQR, 6.0-11.5). As of March 15, 2020, 95.8% of the severe patients had been discharged and only two deaths occurred.

Conclusion: The rate of severe cases and mortality of COVID-19 in Hunan are lower than those in Wuhan. In addition to antivirals and oxygen support, timely interventions including corticosteroids, immunoglobulin, and antibiotics, contribute to improving the prognosis of severe COVID-19 patients.

Keywords: SARS-CoV-2; coronavirus disease 2019; corticosteroid; immunoglobulin; severe disease.