key: cord-0951888-b82xhp2w authors: Yang, Qiuxiang; Xie, Ling; Zhang, Wei; Zhao, Lin; Wu, HuaJun; Jiang, Jie; Zou, Jili; Liu, Jianguang; Wu, Jun; Chen, Yonggang; Wu, Jinhu title: Analysis of the clinical characteristics, drug treatments and prognoses of 136 patients with coronavirus disease 2019 date: 2020-05-25 journal: J Clin Pharm Ther DOI: 10.1111/jcpt.13170 sha: 8f8f6b6905ac5633688a165e94cb64045c384c9e doc_id: 951888 cord_uid: b82xhp2w WHAT IS KNOWN AND OBJECTIVE: Since the December 2019 discovery of several cases of coronavirus disease 2019 (COVID‐19) in Wuhan, China, the infection has spread worldwide. Our aim is to report on the clinical characteristics, treatments and prognoses of COVID‐19. METHODS: This was a retrospective, single‐centre, case series of 136 patients who were diagnosed with COVID‐19 at Wuhan Third Hospital in Wuhan, China, between 28 January 2020 and 12 February 2020. The clinical characteristics, laboratory tests, treatment features and prognoses were summarized. RESULTS AND DISCUSSION: The 136 patients were divided into a moderate (M) group (n = 103, 75.7%) and a severe and critical (SC) group (n = 33, 24.3%). There were significant differences in the incidences of concomitant chronic medical illnesses (eg, hypertension, diabetes and cardiovascular disease), fever, dry cough and dyspnoea among the two groups (P < .05). Compared with those in the M group, lymphocyte count (LYM) decreased significantly in the SC group, while the serum levels of C‐reactive protein (CRP), procalcitonin (PCT), creatinine (Cre), D‐dimer, lactic dehydrogenase (LDH), myoglobin (MB) and troponin I (cTnl) increased significantly in the SC group (P < .05). The main therapeutic drugs were antivirals, antibiotics, glucocorticoids, immunomodulators, traditional Chinese medicine preparations and symptomatic support drugs. There were significant differences in the incidences of shock, myocardial injury, acute respiratory distress syndrome (ARDS) and renal injury among the two groups (P < .05). Among the 136 patients, 99 (72.7%) were cured, 14 (10.3%) were transferred to other hospital and 23 (16.9%) died. WHAT IS NEW AND CONCLUSION: Elderly patients with chronic diseases are more likely to develop severe or critical COVID‐19 with multiple organ damage or systemic injuries. The improvement of LYM and CRP may be associated with the prognoses of COVID‐19. The combined use of three or more antiviral drugs is to be avoided. The combination of broad‐spectrum antibacterial drugs is not recommended and the risk of drug‐induced liver injury should be monitored. Throughout a patient's hospitalization, their treatment plan should be evaluated and adjusted according to their vital signs, clinical symptoms, laboratory tests and imaging changes. Patients should receive effective psychological counselling. In December 2019, several patients were diagnosed with in Wuhan, China. Since that time, COVID-19 has become a worldwide pandemic. Therefore, the National Health Commission (NHC) of China has classified COVID-19 as a management category B infectious disease and adopted the prevention and control measures of category A infectious diseases. [1] [2] [3] [4] Wuhan Third Hospital was designated to treat COVID-19, and it developed several mobile cabins for this purpose. In this study, we analysed the clinical characteristics, laboratory test data, medication features and clinical prognoses of 136 patients with confirmed COVID-19, so as to provide reference data for frontline anti-pandemic control. A total of 599 patients with COVID-19 were admitted to Wuhan Third Hospital from 28 January 2020 to 12 February 2020. Of these, 136 patients were included in this study. These patients all had confirmed COVID-19 and were either discharged well, transferred to another hospital or died. Referring to the Diagnosis and Treatment Plan for COVID-19 (the 7th trial edition) issued by the NHC, COVID-19 was diagnosed by positive COVID-19 nucleic acid in fluorescent real-time polymerase chain reaction (RT-PCR) assays. The clinical typing of COVID-19 is described below: (a) mild type: non-pneumonia; (b) moderate type: fever and respiratory symptoms, pneumonia manifestations in the imaging; (c) severe type: shortness of breath with respiratory rate (RR) ≥30 bpm or finger SpO 2 ≤93% at rest; (d) critical type: respiratory failure (requiring mechanical ventilation), shock or other organ failure (requiring ICU monitoring and treatment). The criteria for discharge were as follows: a normal body temperature for 3+ days; remarkable mitigation of respiratory symptoms; significant improvement of acute exudative lesions on lung imaging; and negative for COVID-19 nucleic acid on two successive respiratory sample tests. 1 Mild patients were not included in this study. Moderate patients were treated as one group (M), and severe and critical patients were another group (SC). Moderate patients were given symptomatic treatment. Severe and critical patients were given active prevention of complications and multi-organ function support based on symptomatic treatment. The patient enrolment and outcomes were shown in Figure 1. The patients' relevant data were collected on the hospital informa- spss 25.0 software was used for statistical analysis. The qualitative data were presented as percentage (%) and compared with a chisquared test. The quantitative data were described with median (interquartile range [IQR] ) and compared with a rank sum test; those of normal distribution were t test. P < .05 suggested that a difference was statistically significant. Hospital admission (IQR), d 8.0 (5-10) 8.2 (6-10) 7.2 (5) (6) (7) (8) .077 Abbreviations: IQR, interquartile range. P values indicate differences between the SC group and the M group, and P < .05 was considered statistically significant. COVID-19 cases were the medical staff, all of which were in M group. Of the 136 patients, 51 (37.5%) had one or more concomitant chronic diseases. Hypertension (26.5%), diabetes (14.7%) and cardiovascular disease (6.6%) were the most common concomitant conditions. Compared with the patients in the M group, the patients in the SC group were older and a higher percentage had concomitant diseases. The common initial symptoms were fever (91.9%), dry cough (86.0%), anorexia (53.7%), fatigue (39.0%) and insomnia (36%). The time from symptom onset to hospitalization was 8.0 (5-10) days (Table 1 ). There was a 0.9 (0.7-1. LDH, MB and cTnI were markedly increased (P < .05) ( Table 2 ). The drug treatments mainly included antiviral drugs, antibacterial P values indicate differences between the SC group and the M group, and P < .05 was considered statistically significant. with low molecular heparin (LMWH) for anticoagulation; a statistically significant difference was found between the two groups in utilization (P < .001). Eight (24.2%) patients in the SC group were given oxygen by nasal cannula, 5 (15.2%) patients were given high flow nasal cannula (HFNC) oxygen therapy, and 20 (60.6%) patients received non-invasive mechanical ventilation; the difference between the two groups was statistically significant (P < .001; Table 3 ). Figure 2 . Compared with the laboratory test data at admission, the WBC, LYM and ALT of the M group patients were significantly increased after hospitalization, while CRP was decreased (P < .05). The SC group showed no statistically significant difference in laboratory test data before and after hospitalization with the exception of WBC (which was increased after treatment; Table 4 ). This study showed that SC group was older and more suffered from concomitant chronic underlying diseases (eg, hypertension and diabetes) than the M group. This indicates that increased age and comorbidities were likely risk factors for becoming severely or critically ill when suffering from COVID-19. 5 The most significant laboratory test data at admission were decreased LYM and increased CRP and LDH. In the SC patients, there were decreased LYM and increased NEU%, CRP and PCT. The above changes in this study suggest that COVID-19 may have a cellular immune impairment process. 6,7 LDH, MB and cTnI in the SC patients were significantly higher than those of M patients, which might be due to COVID-19 infecting the myocardium followed by immune cell infiltration into the infected myocardium releasing fibrogenic cytokines and proinflammatory factors that cause myocardial injury. Coronavirus may influence the coagulation system; APTT was prolonged in partial patients, and D-dimer was significantly increased in critical patients. Some studies have shown that coronavirus can promote coagulation accentuation via inflammatory factors, which in turn contributes to immune escape. lopinavir/ritonavir, moxifloxacin and methylprednisolone) used to treat patients include liver dysfunction. 12, 13 The combinations of these drugs may have been one of the causes of abnormal liver function. In addition, the combination of drugs that are metabolized by the hepatic CYP3A4 enzyme (eg, methylprednisolone and lopinavir/litonavir) further increases the risk of liver dysfunction. Because the induction and inhibition of liver drug enzymes or their competition with substrates affect the drug metabolism, using multiple medications which are metabolized by the same enzyme may slow drug metabolism resulting in an increase of those medications in the body. 14 Therefore, the drug factor may be one of the causes for liver dysfunction in COVID-19 patients. Systemic cytokine storm and multiple organ failure may also be responsible for liver function damage. 15 None. All authors contributed substantially to the conception and design of the study, and data analysis and interpretation. All authors contributed to the drafting and editing of the article and have granted their approval of the submitted manuscript. Qiuxiang Yang https://orcid.org/0000-0002-6134-0653 ARDS, acute respiratory distress syndrome 05: P values indicate differences between the SC group and M group at discharge; P values indicate differences between admission and discharge within the two groups respectively New coronavirus pneumonia diagnosis and treatment program p/20200 3/46c92 94a7d fe4ce f80dc 7f591 2eb19 89.shtml. 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