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Therapeutic response to corticosteroids in a critically ill patient with COVID-19: A case report

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Kaige Wang
Kaige Wang
Kaige Wang
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Fen Tan
Fen Tan
Fen Tan
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Rui Zhou
Rui Zhou
Rui Zhou
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Dan Liu
Dan Liu
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Abstract and Figures

Introduction: Since the coronavirus disease 2019 (COVID-19) outbreak in Wuhan in late 2019, controversy on the use of corticosteroids for COVID-19 has obtained increasing attention. We present 1 critically ill patient who had a rapid therapeutic response to moderate-dose corticosteroids. Patient concerns: A 53-year-old critically ill woman from Wuhan suffered with COVID-19. Diagnosis: The chest computed tomography scan was suggestive of COVID-19. The diagnosis was confirmed by a real-time reverse transcription polymerase chain reaction test for SARS-CoV-2. The critically ill status was characterized by worsening dyspnea, progressing bilateral lung consolidation, and poor oxygenation (SiO2/FiO2:110 mm Hg). Interventions: The patient was treated with a moderate dose of intravenous corticosteroids and high-flow nasal cannula oxygen therapy. Outcomes: After the initiation of corticosteroids, the patient rapidly improved over the following 6 days. Serial chest computed tomography scans showed good absorption of the consolidations. The patient was discharged on Day 17 of hospitalization without obvious adverse effects. Conclusions: Early use of moderate-dose corticosteroids over a short period may enhance recovery from COVID-19 in critically ill patients.
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Therapeutic response to corticosteroids in a
critically ill patient with COVID-19
A case report
Kaige Wang, MD
a
, Fen Tan, MD
b
, Rui Zhou, PhD
b
, Dan Liu, PhD
a
, Zhong Ni, MD
a
,
Jiasheng Liu, PhD
c
, Fengming Luo, PhD
a,∗
Abstract
Introduction: Since the coronavirus disease 2019 (COVID-19) outbreak in Wuhan in late 2019, controversy on the use of
corticosteroids for COVID-19 has obtained increasing attention. We present 1 critically ill patient who had a rapid therapeutic
response to moderate-dose corticosteroids.
Patient concerns: A 53-year-old critically ill woman from Wuhan suffered with COVID-19.
Diagnosis: The chest computed tomography scan was suggestive of COVID-19. The diagnosis was confirmed by a real-time
reverse transcription polymerase chain reaction test for SARS-CoV-2. The critically ill status was characterized by worsening
dyspnea, progressing bilateral lung consolidation, and poor oxygenation (SiO
2
/FiO
2
:110 mm Hg).
Interventions: The patient was treated with a moderate dose of intravenous corticosteroids and high-flow nasal cannula oxygen
therapy.
Outcomes: After the initiation of corticosteroids, the patient rapidly improved over the following 6 days. Serial chest computed
tomography scans showed good absorption of the consolidations. The patient was discharged on Day 17 of hospitalization without
obvious adverse effects.
Conclusions: Early use of moderate-dose corticosteroids over a short period may enhance recovery from COVID-19 in critically ill
patients.
Abbreviations: ARDS =acute respiratory distress syndrome, COVID-19 =coronavirus disease 2019, CT =computed
tomography, CRP =C-reactive protein, SARS-CoV-2 =severe acute respiratory syndrome coronavirus 2, rRT-PCR =real-time
reverse transcriptionpolymerase chain reaction.
Keywords: corticosteroids use, critically ill patient, COVID-19, SARS-CoV2
1. Introduction
Since the coronavirus disease 2019 (COVID-19) outbreak began
in Wuhan in December 2019, COVID-19 has become pandemic,
with more than 8 million laboratory-confirmed cases by June 22,
2020.
[1]
According to early reports from China, 16% of
hospitalized patients infected with severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) experience severe dis-
ease,
[2]
and of 17% to 29% of patients hospitalized with SARS-
CoV-2 infection has been reported to develop acute respiratory
distress syndrome (ARDS).
[3,4]
There is currently no targeted
antiviral treatment for COVID-19. Supportive care is provided to
help relieve symptoms and protect organ function. According to
the opinions of some experts,
[5]
corticosteroids should not be used
in patients with SARS-CoV-2-induced lung injury or shock.
Recently, the results of a clinical trial in the UK show that low dose
dexamethasone can reduce the mortality of COVID-19 patients
with mechanical ventilation by about one third.
[6]
However, many
clinicians have a different perspective, based on their clinical
experience.
[7]
We report a case of a critically ill patient with
COVID-19 pneumonia who recovered after corticosteroid thera-
py. This case illustrates the potential benefits of corticosteroid
therapy for COVID-19. The report was approved by RHWU
Research Ethics Committee (WDRY2020-K068). The patient has
provided informed consent for publication of the case.
2. Case report
A 53-year-old woman living in Wuhan, China was admitted to a
designated COVID-19 hospital because of fever and cough. The
fever had started 1 week previously without obvious cause, and
Editor: Maya Saranathan.
KW and FT contributed equally to this work.
The authors have no conflicts of interest to disclose.
All data generated or analyzed during this study are included in this published
article [and its supplementary information files].
a
Department of Pulmonary and Critical Care Medicine, West China Hospital,
Sichuan University, Chengdu,
b
Department of Pulmonary and Critical Care
Medicine, The Second Xiangya Hospital, Central South University, Respiratory
Disease Research Institute of Hunan Province, Changsha,
c
Department of
Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
∗
Correspondence: Fengming Luo, Department of Pulmonary and Critical Care
Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
(e-mail: luofengming@hotmail.com).
Copyright ©2020 the Author(s). Published by Wolters Kluwer Health, Inc.
This is an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
How to cite this article: Wang K, Tan F, Zhou R, Liu D, Ni Z, Liu J, Luo F.
Therapeutic response to corticosteroids in a critically ill patient with COVID-19: A
case report. Medicine 2020;99:31(e21597).
Received: 20 March 2020 / Received in final form: 28 June 2020 / Accepted: 8
July 2020
http://dx.doi.org/10.1097/MD.0000000000021597
Clinical Case Report Medicine®
OPEN
1
her highest recorded body temperature was 38.4°C. She also had
a dry cough without chest pain, hemoptysis, or diarrhea. Her
initial chest computed tomography (CT) (Fig. 1A) showed
ground-glass exudative lesions scattered in both lungs. The test
for SARS-CoV-2 infection by real-time reverse transcription
polymerase chain reaction (RT-PCR) assay of oropharyngeal
swabs was negative. She was initially treated with oseltamivir in
outpatient department. However, her condition worsened, and
developed dyspnea, requiring designated wards hospitalization.
She had the history of hypertension with long-term administra-
tion of amlodipine.
On presentation, her temperature was 38.3°C. Her other signs
were: respiratory rate 28/min; SiO2/Fio2 170 mm Hg; body
weight 68 kg; heart rate 106/min; blood pressure of both arms
108/ 70mm Hg. Cardiovascular examination revealed tachycar-
dia with regular rhythm, normal first and second heart sounds,
and no murmurs, gallops or rubs. On auscultation of the lung
fields, breath sounds were coarse with wet rales scattered at
both lungs. Her abdomen was soft and non tender with no
palpable organomegaly. Neurological examination did not reveal
any focal neurological deficit.
On hospitalization, her whole blood cell count showed
neutrophilia, and lymphopenia. She had a markedly elevated
C-reactive protein (CRP). The detailed information and the change
in the whole hospital course are shown in Table 1. The test for
COVID-19 infection by RT-PCR assay was positive. Additional
laboratory parameters including alanine aminotransferase, aspar-
tate aminotransferase, and creatinine levels were normal.
Procalcitonin, G-test, GM-test, and antibody against influenza A
virus and influenza B virus were negative, as well as antineutrophil
cytoplasmic antibody and antinuclear antibody. Repeated chest
CT showed progressive consolidation in both lungs (Fig. 1B). The
patient was laboratory confirmed COVID-19. After admission,
we treated him with antiviral (arbidol and thymosin a1) and
oxygenation supportive with high flow nasal cannula for 2 days.
However, on Day 3, the patient dyspnea worsened rapidly. Her
respiratory rate was increased to 32/min, PaO
2
/FiO
2
decreased to
110mm Hg. The patient refused noninvasive ventilation and
mechanical ventilation. We then treated him with corticosteroids
(80mg twice a day for 3 days, then 40mg twice a day for the
following 3 days), with the patient’s consent. The detailed
treatment is shown in Table 2. Inflammatory makers including
whole blood cellcount and CRP shown in Table 1 and the recordof
parameters of respiratory status overtime shown in Table 2
illustrated the patient’s improvement after therapy. Repeated CT
scan indicated consolidations were absorbed partly on Day 11
Table 1
Change of the whole blood cell count and CRP in the hospitalization.
Parameters Day 1 Day 5 Day 9 Day 13 Day 16 Reference range
Whole blood cell count 7.08 7.83 9.23 10.20 9.65 3.5–9.5/L
Neutrophil count 6.61 6.84 7.80 8.20 6.5 1.8–6.3/L
Lymphocyte count 0.32 0.28 0.82 0.96 0.99 1.1–3.2/L
CRP 122 88 23 11 5 0–5 mg/L
CRP =C-reactive protein.
Figure 1. Serial chest computed tomography images over the course of the illness. A, Day 2: Ground-glass opacities are scattered peripherally in both lungs. B,
Day 8: There is diffuse bilateral consolidation of the ground-glass opacities in both lungs. C, Day 18: The computed tomography (CT) image reveals partial resolution
of the lung consolidation observed in the previous CT scan on Day 8. D, Day 23: The CT scan reveals almost complete resolution of the lung consolidation.
Wang et al. Medicine (2020) 99:31 Medicine
2
(Fig. 1C) and improved obviously on Day 16 (Fig. 1D). Repeated
detection for SARS-CoV-2(performed twice) through oropharyn-
geal swabs was negative. The patient recovered without any
obvious adverse effect and discharged on Day 17.
3. Discussion
This patient living in Wuhan with respiratory symptoms was
suspected of COVID-19 by early chest CT scan. Their RT-PCR
assays in respiratory specimens confirmed the diagnosis.
Negative of procalciton in test, G-test, GM-test indicated no
bacterial or fungal infection. Dyspnea rapidly worsened in the
course of nonspecific antiviral treatment and symptomatic
treatment. The chest CT showed progressing consolidation of
the lung. According to Kigali Modification of the Berlin
Criteria,
[8]
the patient was diagnosed as moderate ARDS. Upon
condition worsened to critically illness, the patient was treated
with moderate dose use of corticosteroids for 6 consecutive days.
The condition improved significantly illustrated by the symptoms
and respiratory parameters as well as chest CT. Finally, tracheal
intubation was avoided.
On the corticosteroids use in COVID-19, experts held different
opinions. According to the observational studies on corticoste-
roids treating patients with severe human coronavirus including
SARS-CoV and Middle East respiratory syndrome coronavirus,
and other severe respiratory virus infections, some authors
speculated that corticosteroids use could not benefit for the lung
injury in COVID-19, even for the critically ill patient.
[5]
However, physicians held a different opinion when fought with
COVID-19 in front-line clinical service. Cao and colleagues
recommend prudent use of the corticosteroids in the most
critically ill patients.
[7]
Furthermore, lung pathological manifes-
tation in severe COVID-19 showed pulmonary edema and
hyaline membrane formation.
[9]
This characteristic supports
timely and appropriate use of corticosteroids in critically ill
patients. The consensus statement by the Chinese Thoracic
Society recommends using low-dose corticosteroids (1–2 mg/kg
d, 5–7 days) for critical COVID-19 patients prudently.
[10]
The
timing of application is as follows: Rapid progress in imaging
(more than 50% in 24–48 hours); Under the condition of resting
without oxygen inhalation, SpO2 93%, respiratory distress
(respiratory frequency ≥30 times/min) or oxygenation index
300 mm Hg. (Both conditions need to be met simultaneously.)
The patient described here developed critically ill on Day 9 from
the initial. A short course of corticosteroids at a moderate dose
benefited the patient and prevented from the need of mechanical
ventilation. The consolidation in the lung improved gradually
without obvious adverse effects. Because of the impaired
antibody responses existed in those given corticosteroids in the
previous study,
[11]
adverse effect will be tracked after discharge
for a period.
In conclusion, early use of corticosteroids at moderate dose in
short course may enhance the critically ill COVID-19 patient
recovery. However, this case is a retrospective study, persuasive
clinical evidence is still needed urgently.
Acknowledgments
The authors thank the patient and his family for their kind
cooperation.
Author contributions
Conceptualization: Kaige Wang.
Data curation: Kaige Wang and Fen Tan.
Formal analysis: Fengming Luo.
Funding acquisition: Fengming Luo.
Investigation: Rui Zhou and Fen Tan.
Methodology: Fengming Luo.
Project administration: Kaige Wang and Dan Liu. Resources:
Zhong Ni.
Writing –original draft: Kaige Wang and Fen Tan.
Writing –review & editing: Fengming Luo and Jiasheng Liu.
References
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Table 2
Temperature, blood oxygenation level, detection for nucleic acid of nCoV-2019, and treatment on day of illness and day of hospitalization,
February 1 to February 23, 2020.
Hospitalization
Characteristics Home Day 1 Day 3 Day 5 Day 7 Day 9 Day 11 Day 13 Day 16
Day of illness 1–7810121416182023
Fever (°C) 38.4°C 37.8°C–38.2°C36°C–37°C
PaO2/SiO2 (mm Hg) 170 110 160 180 200 260 290
Oropharyngeal swabs Negative Positive Positive Negative Negative
Pharmacotherapy Oseltamivir Arbidol
Thymosin a1
Methylprednisolone 80mg twice daily
intravenous drip
Methylprednisolone 40mg twice daily
intravenous drip
Oxygen support HFNC Nasal catheter
Date February 1–7 February 8 February 10 February 12 February 14 February 16 February 18 February 20 February 23
HFNC =high-flow nasal cannula.
Wang et al. Medicine (2020) 99:31 www.md-journal.com
3
[8] Riviello ED, Kiviri W, Twagirumugabe T, et al. Hospital incidence and
outcomes of the acute respiratory distress syndrome using the Kigali
modification of the berlin definition. Am J Respir Crit Care Med
2016;193:52–9.
[9] Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19
associated with acute respiratory distress syndrome. Lancet Respir Med
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4
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Full-text available
  • Sep 2021
Background: Since the start of the coronavirus disease 2019 (COVID-19) pandemic, there is an urgent need for effective therapies for patients with COVID-19. In this study, we aimed to assess the therapeutic efficacy of glucocorticoids in severe COVID-19. Methods: A systematic literature search was performed across PubMed, Web of Science, EMBASE, and the Cochrane Library (up to June 26, 2021). The literature investigated the outcomes of interest were mortality and invasive mechanical ventilation. Results: The search identified 13 studies with 6612 confirmed severe COVID-19 patients. Our meta-analysis found that using glucocorticoids could significantly decrease COVID-19 mortality (hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.45-0.79, P < .001), relative to non-use of glucocorticoids. Meanwhile, using glucocorticoids also could significantly decrease the risk of progression to invasive mechanical ventilation for severe COVID-19 patients (HR = 0.69, 95% CI 0.58-0.83, P < .001). Compared with using dexamethasone (HR = 0.68, 95% CI 0.50-0.92, P = .012), methylprednisolone use had a better therapeutic effect for reducing the mortality of patients (HR = 0.35, 95% CI 0.19-0.64, P = .001). Conclusion: The result of this meta-analysis showed that using glucocorticoids could reduce mortality and risk of progression to invasive mechanical ventilation in severe COVID-19 patients.
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The causality between use of glucocorticoids and risk of pancreatitis: a Mendelian randomization study
Article
Full-text available
  • Aug 2024
Background and aim To date, the association between glucocorticoid use and the risk of pancreatitis remains controversial. The aim of this study was the investigation of this possible relationship. Methods We carried out a two-sample Mendelian randomization (MR) analysis using GWAS data from European ancestry, East Asian descendants and the FinnGen Biobank Consortium to evaluate this potential causal relationship. Genetic variants associated with glucocorticoid use were selected based on genome-wide significance (p < 5×10-8). Results Our MR analysis of European ancestry data revealed no significant causal relationship between glucocorticoid use and AP (IVW: OR=1.084, 95% CI= 0.945-1.242, P=0.249; MR-Egger: OR=1.049, 95% CI= 0.686-1.603, P=0.828; weighted median: OR=1.026, 95% CI= 0.863-1.219, P=0.775) or CP (IVW: OR=1.027, 95% CI= 0.850-1.240, P=0.785; MR-Egger: OR= 1.625, 95% CI= 0.913-2.890, P= 0.111; weighted median: OR= 1.176, 95% CI= 0.909-1.523, P= 0.218). Sensitivity analyses, including MR-Egger and MR-PRESSO, indicated no evidence of pleiotropy or heterogeneity, confirming the robustness of our findings. Multivariable MR analysis adjusted for alcohol consumption, BMI, cholelithiasis and C-reactive protein levels supported these findings. Replicated analysis was performed on datasets from the FinnGen Biobank Consortium and East Asian descendants, and similar results were obtained. Conclusions This MR analysis suggests that there is no causal association between glucocorticoid use and the risk of pancreatitis.
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COVID-19 and corticosteroids: a narrative review
Article
Full-text available
  • May 2022
  • InflammoPharmacology
It has been reported that corticosteroid therapy was effective in the management of severe acute respiratory syndrome (SARS) and the Middle East Respiratory Syndrome (MERS), and recently in coronavirus disease 2019 (COVID-19). Corticosteroids are potent anti-inflammatory drugs that mitigate the risk of acute respiratory distress syndrome (ARDS) in COVID-19 and other viral pneumonia, despite a reduction of viral clearance; corticosteroids inhibit the development of cytokine storm and multi-organ damage. The risk-benefit ratio should be assessed for critical COVID-19 patients. In conclusion, corticosteroid therapy is an effective way in the management of COVID-19, it reduces the risk of complications primarily acute lung injury and the development of ARDS. Besides, corticosteroid therapy mainly dexamethasone and methylprednisolone are effective in reducing the severity of COVID-19 and associated comorbidities such as chronic obstructive pulmonary diseases (COPD), rheumatoid arthritis, and inflammatory bowel disease (IBD).
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Clinical Characteristics of Coronavirus Disease 2019 in China
Article
Full-text available
  • Feb 2020
Background: Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods: We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results: The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions: During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.).
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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
Article
Full-text available
  • Jan 2020
Background: A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods: All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings: By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0-58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0-13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation: The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding: Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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The Effect of Steroid Use in Hospitalized Adults With Respiratory Syncytial Virus-Related Illness
Article
Full-text available
  • May 2011
  • CHEST
Systemic glucocorticosteroids (steroids) are commonly prescribed for patients with exacerbations of COPD during acute viral infections such as respiratory syncytial virus (RSV). The effects of short-term high-dose steroid treatment on viral load and adaptive immunity to RSV have not been examined in adults. The objectives of this study were to measure peak viral load and duration of viral shedding, serum and nasal cytokines, RSV-specific antibody response, and lymphocyte subsets in patients admitted to the hospital with RSV infection and to compare patients treated with steroids to patients untreated with steroids. Hospitalized adults who tested positive for RSV by reverse transcription-polymerase chain reaction (RT-PCR) on admission had respiratory samples collected for quantitative RT-PCR and cytokine analysis. Serum and nasal secretions were tested for RSV antibody and lymphocyte subsets were analyzed by flow cytometry at 2 days, 2 weeks, and 1 month. Thirty-three of 50 (66%) patients hospitalized with RSV received systemic steroids for a mean duration of 11 days. Those who received steroids more frequently wheezed and were less often febrile. There were no serious adverse events related to steroids and no significant differences in peak viral load, duration of RSV shedding, nasal cytokines, or lymphocyte subsets in patients treated with steroids and patients untreated with steroids. Antibody responses to RSV were slightly blunted in the steroid-treated group. Short courses of systemic steroids in patients hospitalized with RSV infection did not affect viral load or shedding. Humoral immunity may be mildly diminished, and thus potential benefits of systemic steroids must be balanced against potential risks.
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Coronavirus breakthrough: dexamethasone is first drug shown to save lives
Article
  • Jun 2020
In a large trial, a cheap and widely available steroid cut deaths by one-third among patients critically ill with COVID-19. In a large trial, a cheap and widely available steroid cut deaths by one-third among patients critically ill with COVID-19. Dexamethasone anti-inflammatory steroid tablets
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Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study
Article
  • Jan 2020
Background: In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods: In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings: Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation: The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding: National Key R&D Program of China.
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Hospital Incidence and Outcomes of ARDS Using the Kigali Modification of the Berlin Definition
Article
  • Sep 2015
  • AM J RESP CRIT CARE
Rationale: Estimates of the incidence of the Acute Respiratory Distress Syndrome (ARDS) in high and middle-income countries vary from 10.1 to 86.2 per 100,000 person-years in the general population. The epidemiology of ARDS has not been reported for a low-income country. The Berlin definition may not allow identification of ARDS in resource-constrained settings. Objectives: To estimate the incidence and outcomes of ARDS at a Rwandan referral hospital using the Kigali modification of the Berlin definition: without requirement for positive end expiratory pressure, hypoxia cutoff of SpO2/FiO2 ≤ 315, and lung ultrasound or chest radiograph for bilateral opacities. Methods: We screened every adult patient for hypoxia at a public hospital in Rwanda for six weeks. For every patient with hypoxia, we collected data on demographics and ARDS risk factors and performed lung ultrasonography. Measurements and main results: Fifty-one (4.9%) of 1046 hospital admissions met criteria for ARDS. Using various pre-specified cutoffs for the SpO2/FiO2 ratio resulted in almost identical hospital incidence values. Median age for patients with ARDS was 40 years, and infection was the most common risk factor (45.6%). Only 23.3% of patients with ARDS were admitted to an ICU; among all patients with ARDS, hospital mortality was 52.9%. Using traditional Berlin criteria, no patients would have met criteria for ARDS. Conclusions: ARDS is a common and fatal syndrome in a hospital in Rwanda, with few patients admitted to an ICU. The Berlin definition, while appropriate in high-income countries, underestimates the incidence of ARDS in low-income countries.
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Chinese Association of Chest PhysiciansGuide for the prevention and treatment of coronavirus disease 2019
  • Jan 2020
  • 473-489
Chinese Thoracic Society, Chinese Association of Chest PhysiciansGuide for the prevention and treatment of coronavirus disease 2019. Zhonghua Jie He He Hu Xi Za Zhi 2020;43:473-89.