COVID-19 research briefs: Wuhan patient outcomes, and new Infectious Disease Society of America treatment guidelines
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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.
Copyright © 2020 John Wiley & Sons, Inc.
