COVID-19 research briefs: Wuhan patient outcomes, and new Infectious Disease Society of America treatment guidelines

Daily POEMs

Published: 2020-05-10 © 2020 John Wiley & Sons, Inc.

Clinical question
What were the outcomes for patients infected with COVID-19 in Wuhan, China, in January 2020? What are the current Infectious Disease Society of America treatment guidelines for patients with COVID-19?

Bottom line
This retrospective cohort study of 191 adults hospitalized in Wuhan, China, with confirmed COVID-19 infections who had been discharged or had died by January 31, 2020, reports that 72% were discharged and 28% died as inpatients. The Infectious Disease Society of America (IDSA) guidelines recommend specific agents in the context of a clinical trial (hydroxychloroquine or chloroquine, hydroxychloroquine/chloroquine plus azithromycin, lopinavir/ritonavir) and recommend tailoring use/non-use of corticosteroids in specific populations. (LOE = 4)

Reference
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054-1062. Infectious Diseases Society of America. Guidelines on the treatment and management of patients with COVID-19. www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/. Published April 11, 2020; updated April 21, 2020.

Study design: Other

Setting: Other

Synopsis
Research Brief #16: Researchers from Wuhan conducted a retrospective cohort study of 191 adults hospitalized with confirmed COVID-19 infection who had been discharged or had died by January 31, 2020. Approximately half had a comorbidity: 30% had hypertension, 19% had diabetes, and 8% had coronary heart disease. Most of the patients (72%) were discharged, but 28% died in the hospital. The likelihood of in-hospital death was associated with older age, a higher Sequential Organ Failure Assessment (SOFA) score, and a d-dimer greater than 1 mcg/mL on admission. Although the duration of viral shedding was a median of 20 days in survivors, SARS-CoV-2 was detectable until death in nonsurvivors. The longest observed duration of viral shedding in survivors was 37 days. Research Brief #17: The IDSA used modern guideline development methods that included: a multidisciplinary team of clinicians, public health workers, and methodologists; developing critical PICO-format (Population, Intervention, Comparison, Outcomes) questions; and systematic searches of the research. The authors made 7 recommendations for managing patients hospitalized with confirmed COVID-19, all contingent on using these specific agents in the context of a clinical trial: administer hydroxychloroquine or chloroquine; give hydroxychloroquine/chloroquine plus azithromycin only (emphasis added) in the context of a clinical trial; give lopinavir/ritonavir; do not give corticosteroids to patients with COVID-19 pneumonia (conditional recommendation based on low certainty evidence); patients with respiratory distress syndrome should receive corticosteroids; give tocilizumab only (emphasis added) in the context of a clinical trial; and administer convalescent serum. The most important recommendation from the IDSA was that patients be recruited into randomized trials to overcome the limitations of the existing research.

Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI

Copyright © 2020 John Wiley & Sons, Inc.