Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS Negl Trop Dis. 2021 Jan 6;15(1):e0009051. doi: 10.1371/journal.pntd.0009051. eCollection 2021 Jan.
Until now, no antiviral treatment has been proven to be effective for the coronavirus disease 2019 (COVID-19). The timing of oxygen therapy was considered to have a great influence on the symptomatic relief of hypoxemia and seeking medical intervention, especially in situations with insufficient medical resources, but the evidence on the timing of oxygen therapy is limited.
Medical charts review was carried out to collect the data of hospitalized patients with COVID-19 infection confirmed in Tongji hospital, Wuhan from 30th December 2019 to 8th March 2020. In this study, the appropriate timing of oxygen therapy and risk factors associated with severe and fatal illness were identified and the effectiveness of antivirus on disease progression was assessed. Among 1362 patients, the prevalence of hypoxia symptoms was significantly higher in those patients with severe and fatal illness than in those with less severe disease. The onset of hypoxia symptoms was most common in the second to third week after symptom onset, and patients with critical and fatal illness experienced these symptoms earlier than those with mild and severe illness. In multivariable analyses, the risk of death increased significantly when oxygen therapy was started more than 2 days after hypoxia symptoms onset among critical patients (OR, 1.92; 95%CI, 1.20 to 3.10). Compared to the critically ill patients without IFN-a, the patients who were treated with IFN-a had a lower mortality (OR, 0.60; 95%CI, 0.39 to 0.91).
Early initiation of oxygen therapy was associated with lower mortality among critical patients. This study highlighted the importance of early oxygen therapy after the onset of hypoxia symptoms. Our results also lend support to potentially beneficial effects of IFNα on critical illness.
到目前为止，还没有有效的抗病毒治疗方法被证明对 2019 年冠状病毒病（COVID-19）有效。氧疗的时机被认为对缓解低氧血症的症状和寻求医疗干预有很大影响，特别是在医疗资源不足的情况下，但关于氧疗时机的证据有限。
对 2019 年 12 月 30 日至 2020 年 3 月 8 日在武汉同济医院住院的 COVID-19 感染患者的病历进行了回顾性分析。本研究确定了氧疗的适当时机以及与严重和致命疾病相关的危险因素，并评估了抗病毒药物对疾病进展的影响。在 1362 名患者中，严重和致命疾病患者的缺氧症状发生率明显高于病情较轻的患者。缺氧症状最常见于症状出现后的第二至第三周，且危重症和死亡患者出现这些症状的时间早于轻症和重症患者。多变量分析显示，危重症患者在出现缺氧症状后 2 天以上开始氧疗时，死亡风险显著增加（OR，1.92；95%CI，1.20 至 3.10）。与未接受 IFN-a 治疗的危重症患者相比，接受 IFN-a 治疗的患者死亡率较低（OR，0.60；95%CI，0.39 至 0.91）。
早期开始氧疗与危重症患者的死亡率降低有关。本研究强调了在出现缺氧症状后早期进行氧疗的重要性。我们的结果还支持 IFNα 对危重症可能有益的作用。
