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

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.

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.