Abstract
Progressive acute respiratory distress syndrome (ARDS) is the most lethal cause in patients with severe COVID-19 pneumonia due to uncontrolled inflammatory reaction, for which we found that early intervention of combined treatment with methylprednisolone and human immunoglobulin is a highly effective therapy to improve the prognosis of COVID-19-induced pneumonia patients. Objective. Herein, we have demonstrated the clinical manifestations, laboratory, and radiological characteristics of patients with severe Coronavirus Disease-2019 (COVID-19) pneumonia, as well as measures to ensure early diagnosis and intervention for improving clinical outcomes of COVID-19 patients. Summary Background Data. The COVID-19 is a new infection caused by a severe acute respiratory syndrome- (SARS-) like coronavirus that emerged in China in December 2019 and has claimed millions of lives. Methods. We included 37 severe COVID-19 pneumonia patients who were hospitalized at Taizhou Public Health Medical Center in Zhejiang province from January 17, 2020, to February 18, 2020. Demographic, clinical, and laboratory features; imaging characteristics; treatment history; and clinical outcomes of all patients were collected from electronic medical records. Results. The patients' mean age was 54 years (interquartile range, 43−64), with a slightly higher male preponderance (57%). The most common clinical features of COVID-19 pneumonia were fever (29 (78%)), dry cough (28 (76%)), dyspnea (9 (24%)), and fatigue (9 (24%)). Serum interleukin (IL)-6 and IL-10 were elevated in 35 (95%) and 19 (51%) patients, respectively. Chest computerized tomography scan revealed bilateral pneumonia in 35 (95%) patients. Early intervention with a combination of methylprednisolone and human immunoglobulin was highly effective in improving the prognosis of these patients. Conclusions. Progressive acute respiratory distress syndrome is the most common cause of death in patients with severe COVID-19 pneumonia owing to an uncontrolled inflammatory response. Early intervention with methylprednisolone and human immunoglobulin was highly effective in improving their prognosis.
Highlights
In December 2019, a novel coronavirus was identified in patients with viral pneumonia in Wuhan, which was later named Coronavirus Disease-2019 (COVID-19) by the World Health Organization (WHO) on January 11, 2020 [1, 2]
COVID-19 patients rarely have gastrointestinal symptoms, such as diarrhea, which is different from the symptoms of severe acute respiratory syndrome- (SARS-)coronavirus and Middle-East respiratory syndrome (MERS)-coronavirus infections [11, 12]
Similar to recent reports [13,14,15], a reduced absolute lymphocyte count was found in 76% of critically ill patients
Summary
In December 2019, a novel coronavirus was identified in patients with viral pneumonia in Wuhan, which was later named Coronavirus Disease-2019 (COVID-19) by the World Health Organization (WHO) on January 11, 2020 [1, 2]. Most coronaviruses usually cause mild illness, but there are two β-coronaviruses, severe acute respiratory syndrome (SARS)-coronavirus and Middle-East respiratory syndrome (MERS)-coronavirus, which can lead to severe acute respiratory syndrome with a mortality rate of 10% and 37%, Computational and Mathematical Methods in Medicine respectively [6, 7]. This study is aimed at describing the clinical, laboratory, and radiological characteristics of critically ill patients with COVID-19, as well as the effective outcomes after early detection and intervention. These findings could provide a useful medicinal strategy for the treatment of severely ill patients with COVID-19 pneumonia
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