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

Abstract

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.

Retracted: The relationship between C‐reactive protein and levels of various cytokines in patients with COVID‐19: A systematic review and correlation analysis

“…15 Furthermore, dynamic cytokine storms as well as high serum IL-6 and TNF-serum levels, were found to be independent and significant predictors of disease severity and death. 4,16,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] Conversely, some interleukins have been reported by studies indicating that they are not linked to the prognosis of this disease.…”

Do Mechanically Ventilated COVID-19 Patients Present a Higher Case-Fatality Rate Compared With Other Infectious Respiratory Pandemics? A Systematic Review and Meta-Analysis

“…Finally, a total of 61 peer-reviewed studies were included in the final analysis (Fig. 1A) 10,12,13,21–78 . Of these final 61 studies, 11 studies were conducted in China, 3 were conducted in America (2 studies from South America and 1 study from Central America), 17 involved centers in the United States, 16 involved centers in Europe, 3 involved centers in Canada, 9 involved centers in Asia, and 2 were based on multinational collaborations (one was between the United Kingdom and Ireland, and the second was between the United States, Europe, Canada, and Japan).…”

Correlation Between COVID-19 Severity, Body Mass Index and Radiological Hepatic Morphology

“…A large study in UK assessed liver fat and liver fibroinflammatory disease by MRI. The study concluded that hepatic steatosis, rather than underlying obesity, increases the risk of infection and hospitalization for COVID-19 (Zhu et al, 2021). Another study showed higher frequency of hepatic steatosis at CTscan among COVID-19-positive patients (Medeiros et al, 2020).…”