National Clinical Research Center for Cardiovascular Diseases, State Key, Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for, Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union, Medical College, Beijing, People's Republic of China.
Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou Province, People's Republic of China.
Phytomedicine. 2021 May;85:153531. doi: 10.1016/j.phymed.2021.153531. Epub 2021 Feb 28.
Qingfei Paidu Tang (QPT), a formula of traditional Chinese medicine, which was suggested to be able to ease symptoms in patients with Coronavirus Disease 2019 (COVID-19), has been recommended by clinical guidelines and widely used to treat COVID-19 in China. However, whether it decreases mortality remains unknown.
We aimed to explore the association between QPT use and in-hospital mortality among patients hospitalized for COVID-19.
A retrospective study based on a real-world database was conducted.
We identified patients consecutively hospitalized with COVID-19 in 15 hospitals from a national retrospective registry in China, from January through May 2020. Data on patients' characteristics, treatments, and outcomes were extracted from the electronic medical records. The association of QPT use with COVID-19 related mortality was evaluated using Cox proportional hazards models based on propensity score analysis.
Of the 8939 patients included, 28.7% received QPT. The COVID-19 related mortality was 1.2% (95% confidence interval [CI] 0.8% to 1.7%) among the patients receiving QPT and 4.8% (95% CI 4.3% to 5.3%) among those not receiving QPT. After adjustment for patient characteristics and concomitant treatments, QPT use was associated with a relative reduction of 50% in-hospital COVID-19 related mortality (hazard ratio, 0.50; 95% CI, 0.37 to 0.66 p < 0.001). This association was consistent across subgroups by sex and age. Meanwhile, the incidences of acute liver injury (8.9% [95% CI, 7.8% to 10.1%] vs. 9.9% [95% CI, 9.2% to 10.7%]; odds ratio, 0.96 [95% CI, 0.81% to 1.14%], p = 0.658) and acute kidney injury (1.6% [95% CI, 1.2% to 2.2%] vs. 3.0% [95% CI, 2.6% to 3.5%]; odds ratio, 0.85 [95% CI, 0.62 to 1.17], p = 0.318) were comparable between patients receiving QPT and those not receiving QPT. The major study limitations included that the study was an observational study based on real-world data rather than a randomized control trial, and the quality of data could be affected by the accuracy and completeness of medical records.
QPT was associated with a substantially lower risk of in-hospital mortality, without extra risk of acute liver injury or acute kidney injury among patients hospitalized with COVID-19.
清肺排毒汤（QPT）是一种中药方剂，被建议能缓解 2019 冠状病毒病（COVID-19）患者的症状，已被临床指南推荐并广泛用于治疗中国的 COVID-19。然而，它是否能降低死亡率仍不清楚。
我们旨在探讨 QPT 使用与 COVID-19 住院患者院内死亡率之间的关联。
这是一项基于真实世界数据库的回顾性研究。
我们从中国全国回顾性登记处的 15 家医院连续纳入 COVID-19 住院患者，时间为 2020 年 1 月至 5 月。从电子病历中提取患者特征、治疗和结局的数据。采用基于倾向评分分析的 Cox 比例风险模型评估 QPT 使用与 COVID-19 相关死亡率之间的关联。
在纳入的 8939 例患者中，28.7%接受了 QPT。接受 QPT 的患者 COVID-19 相关死亡率为 1.2%（95%置信区间 [CI] 0.8%至 1.7%），未接受 QPT 的患者 COVID-19 相关死亡率为 4.8%（95% CI 4.3%至 5.3%）。调整患者特征和伴随治疗后，QPT 使用与院内 COVID-19 相关死亡率降低 50%相关（风险比，0.50；95% CI，0.37 至 0.66，p<0.001）。这种关联在按性别和年龄划分的亚组中是一致的。同时，急性肝损伤的发生率（8.9% [95% CI，7.8%至 10.1%] vs. 9.9% [95% CI，9.2%至 10.7%]；比值比，0.96 [95% CI，0.81%至 1.14%]，p=0.658）和急性肾损伤的发生率（1.6% [95% CI，1.2%至 2.2%] vs. 3.0% [95% CI，2.6%至 3.5%]；比值比，0.85 [95% CI，0.62%至 1.17%]，p=0.318）在接受 QPT 和未接受 QPT 的患者之间无差异。主要研究局限性包括该研究是基于真实世界数据的观察性研究，而非随机对照试验，且病历的准确性和完整性可能影响数据质量。
QPT 与 COVID-19 住院患者的院内死亡率显著降低相关，且不增加急性肝损伤或急性肾损伤的风险。
