Combined Interventions for Severe Novel Coronavirus Disease (COVID-19): Experience from 350 Patients

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

PURPOSE: To summarize the clinical features and effective therapy of severe COVID-19 patients. PATIENTS AND METHODS: In this retrospective, multicenter study, the medical records of COVID-19 patients in Hunan, from January 21, 2020 to February 19, 2020 were reviewed. RESULTS: 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%, P=0.001), D-dimer > 1 mg/L (41.7% vs 13.6%, P<0.0001), higher level of CRP (39.1 mg/L, IQR18.1–75.9 vs 13.4 mg/L, IQR5.0–32.8, P<0.0001), and multiple pneumonia on CT (77.1% vs 18.2%, P<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. CONCLUSION: 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.