Guo Ting, Shen Qinxue, Zhou Zhiguo, Li Jinhua, Guo Wei, He Wenlong, Wang Yunnian, Xiang Zhi, Huang Peng, Zeng Nanyang, Qin Qingwu, Chen Ping, Luo Hong, Peng Hong
Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, Hunan, People's Republic of China.
Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.
Infect Drug Resist. 2020 Oct 30;13:3907-3918. doi: 10.2147/IDR.S279255. eCollection 2020.
To summarize the clinical features and effective therapy of severe COVID-19 patients.
In this retrospective, multicenter study, the medical records of COVID-19 patients in Hunan, from January 21, 2020 to February 19, 2020 were reviewed.
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%, =0.001), D-dimer > 1 mg/L (41.7% vs 13.6%, <0.0001), higher level of CRP (39.1 mg/L, IQR18.1-75.9 vs 13.4 mg/L, IQR5.0-32.8, <0.0001), and multiple pneumonia on CT (77.1% vs 18.2%, <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.
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.
总结重症新型冠状病毒肺炎（COVID-19）患者的临床特征及有效治疗方法。
在这项回顾性多中心研究中，对2020年1月21日至2020年2月19日湖南省COVID-19患者的病历进行了回顾。
350例COVID-19患者中，13.7%为重症病例。入院时，与非重症患者相比，更多重症患者的中性粒细胞/淋巴细胞比值>3（58.3%对33.8%，P=0.001）、D-二聚体>1mg/L（41.7%对13.6%，P<0.0001）、C反应蛋白（CRP）水平更高（39.1mg/L，四分位间距18.1 - 75.9对13.4mg/L，四分位间距5.0 - 32.8，P<0.0001），且胸部CT显示多发肺炎（77.1%对18.2%，P<0.0001）。所有重症患者均接受了氧疗支持。其中95.8%接受了抗病毒治疗，最常用的治疗方案是洛匹那韦和利托那韦加人干扰素α2b。70.8%的重症患者使用了莫西沙星。重症患者琥珀酸甲泼尼龙的总剂量为640mg（四分位间距360 - 960），使用时长为8.5天（四分位间距6.8 - 11.3）。重症患者免疫球蛋白的总剂量为80g（四分位间距，60 - 140），使用时长为8.0天（四分位间距，6.0 - 11.5）。截至2020年3月15日，95.8%的重症患者已出院，仅2例死亡。
湖南省COVID-19的重症率和死亡率低于武汉。除抗病毒治疗和氧疗支持外，包括糖皮质激素、免疫球蛋白和抗生素在内的及时干预有助于改善重症COVID-19患者的预后。
