Table_6_Optimizing Management to Reduce the Mortality of COVID-19: Experience From a Designated Hospital for Severely and Critically Ill Patients in China.DOCX

Background: The coronavirus disease 2019 (COVID-19) has swept through the world at a tremendous speed, and there is still limited data available on the treatment for COVID-19. The mortality of severely and critically ill COVID-19 patients in the Optical Valley Branch of Tongji Hospital was low. We aimed to analyze the available treatment strategies to reduce mortality.
Methods: In this retrospective, single-center study, we included 1,106 COVID-19 patients admitted to the Optical Valley Branch of Tongji Hospital from February 9 to March 9, 2020. Cases were analyzed for demographic and clinical features, laboratory data, and treatment methods. Outcomes were followed up until March 29, 2020.
Results: Inflammation-related indices (hs-CRP, ESR, serum ferritin, and procalcitonin) were significantly higher in severe and critically ill patients than those in moderate patients. The levels of cytokines, including IL-6, IL2R, IL-8, and TNF-α, were also higher in the critical patients. Incidence of acute respiratory distress syndrome (ARDS) in the severely and critically ill group was 23.0% (99/431). Sixty-one patients underwent invasive mechanical ventilation. The correlation between SpO2/FiO2 and PaO2/FiO2 was confirmed, and the cut-off value of SpO2/FiO2 related to survival was 134.43. The mortality of patients with low SpO2/FiO2 (<134.43) at intubation was higher than that of patients with high SpO2/FiO2 (>134.43) (72.7 vs. 33.3%). Among critical patients, the application rates of glucocorticoid therapy, continuous renal replacement therapy (CRRT), and anticoagulation treatment reached 55.2% (238/431), 7.2% (31/431), and 37.1% (160/431), respectively. Among the intubated patients, the application rates of glucocorticoid therapy, CRRT, and anticoagulation treatment were respectively 77.0% (47/61), 54.1% (33/61), and 98.4% (60/61).
Conclusion: No vaccines or specific antiviral drugs for COVID-19 have been shown to be sufficiently safe and effective to date. Comprehensive treatment including ventilatory support, multiple organ function preservation, glucocorticoid use, renal replacement therapy, anticoagulation, and restrictive fluid management was the main treatment strategy. Early recognition and intervention, multidisciplinary collaboration, multi-organ function support, and personalized treatment might be the key for reducing mortality.

研究背景：2019冠状病毒病（coronavirus disease 2019, COVID-19）已以极快速度席卷全球，目前针对该病的治疗相关可用数据仍较为有限。同济医院光谷院区收治的重症、危重症COVID-19患者死亡率较低，本研究旨在分析现有治疗策略以降低患者死亡率。
研究方法：本研究为单中心回顾性研究，纳入2020年2月9日至3月9日期间于同济医院光谷院区收治的1106例COVID-19患者。对入组病例的人口学与临床特征、实验室检查数据及治疗方案进行分析，随访结局至2020年3月29日。
研究结果：重症及危重症患者的炎症相关指标[高敏C反应蛋白（hs-CRP）、红细胞沉降率（ESR）、血清铁蛋白及降钙素原]水平显著高于普通型患者。危重症患者的细胞因子水平，包括白细胞介素-6（IL-6）、白细胞介素-2受体（IL2R）、白细胞介素-8（IL-8）及肿瘤坏死因子-α（TNF-α），亦显著升高。重症及危重症组急性呼吸窘迫综合征（ARDS）发生率为23.0%（99/431）。共61例患者接受有创机械通气治疗。本研究证实了脉搏血氧饱和度/吸入氧浓度比（SpO2/FiO2）与动脉血氧分压/吸入氧浓度比（PaO2/FiO2）之间的相关性，且与患者生存相关的SpO2/FiO2截断值为134.43。气管插管时脉搏血氧饱和度/吸入氧浓度比较低（<134.43）的患者死亡率高于该比值较高（>134.43）的患者（72.7% vs 33.3%）。在危重症患者中，糖皮质激素治疗、连续性肾脏替代治疗（CRRT）及抗凝治疗的应用率分别为55.2%（238/431）、7.2%（31/431）及37.1%（160/431）。在接受气管插管的患者中，糖皮质激素治疗、CRRT及抗凝治疗的应用率分别为77.0%（47/61）、54.1%（33/61）及98.4%（60/61）。
研究结论：截至目前，尚无针对COVID-19的疫苗或特异性抗病毒药物被证实具备足够的安全性与有效性。包括呼吸支持、多器官功能保护、糖皮质激素应用、肾脏替代治疗、抗凝治疗及限制性液体管理在内的综合治疗是主要的治疗策略。早期识别与干预、多学科协作、多器官功能支持及个体化治疗或为降低患者死亡率的关键。