ABSTRACT
As a traditional Chinese medicine, Lianhua Qingwen capsules have been widely used to treat Coronavirus Disease 2019 (COVID-19). This study was aimed to demonstrate the association between treatment with Lianhua Qingwen capsules and the clinical outcomes of hospitalized patients with COVID-19. This retrospective study was conducted at four hospitals in Central China. Data of hospitalized COVID-19 patients were collected between December 19, 2019 and April 26, 2020. Based on whether Lianhua Qingwen capsules were used, patients were classified into Lianhua Qingwen and non-Lianhua Qingwen (control) groups. To control for confounding factors, we used conditional logistic regression in a propensity-score matched (PSM) cohort (1 : 1 balanced), as well as logistic regression without matching as sensitivity analysis. A total of 4918 patients were included, 2760 of whom received Lianhua Qingwen capsules and 2158 of whom did not. In the PSM model, after adjusting for confounders, the in-hospital mortality was similar between the Lianhua Qingwen group and the control group (6.8% vs. 3.3%, adjusted OR, 0.66 [95% CI, 0.38-1.15], p = 0.138). The negative conversion rate of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection was higher in the Lianhua Qingwen group (88.3% vs. 96.1%, adjusted OR, 4.02 [95% CI, 2.58-6.25], p < 0.001). The incidence of acute liver injury was comparable between the two groups (14.0% vs. 11.5%, adjusted OR: 0.85 [95% CI, 0.71-1.02], p = 0.083), and the incidence of acute kidney injury was lower in the Lianhua Qingwen group (5.3% vs. 3.0%, adjusted OR: 0.71 [95% CI, 0.50-1.00], p = 0.048). Treatment with Lianhua Qingwen capsules was not significantly associated with in-hospital mortality in COVID-19 patients. In the Lianhua Qingwen group, the negative conversion rate of SARS-CoV-2 infection was higher and the incidence of acute kidney injury was lower than in the control group.
ABSTRACT
Ambroxol is a commonly used mucolytic agent principally used to treat respiratory diseases, which may have a role as adjunctive therapy for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but there is lack of evidence about its effectiveness on coronavirus disease-2019 (COVID-19) patients. To study the association between ambroxol use and clinical outcomes among hospitalized patients of COVID-19 infection. We conducted a multicenter retrospective cohort study involving 3,111 patients with confirmed SARS-CoV-2 infection from three hospitals in Wuhan from 19 December 2019 to 15 April 2020, and the primary outcome was in-hospital mortality. COVID-19 patients were classified into ambroxol and non-ambroxol groups based on the administration of ambroxol during hospitalization. Two analyses including propensity score matching (PSM) to obtain a 1:1 balanced cohort and logistic regression were used to control for confounding factors. The average age of 3,111 patients was 57.55 ± 14.93 years old, 127 of them died during hospitalization, and 924 of them used ambroxol. Treatment with ambroxol did not have a significant effect on in-hospital mortality of COVID-19 patients when compared with non-ambroxol in PSM model after adjusting for confounders (8.0% vs. 3.5%, adjusted OR, 1.03 [95% CI, 0.54-1.97], p = 0.936). Adverse events such as nausea/vomiting, headache, and rash were comparable between the two groups. Our results suggest that the use of ambroxol is not significantly associated with in-hospital mortality in COVID-19 patients, which provides evidence for evaluating the effects of ambroxol on COVID-19 patient outcomes and may be helpful for physicians considering medication alternatives for COVID-19 patients.
ABSTRACT
Purpose: We aimed to analyze the changes in the disease spectrum data of a pediatric intensive care unit (PICU) in Nanjing, China, during the COVID-19 outbreak and explore a feasible plan for the treatment of critically ill children. Methods: This retrospective study used data from our PICU from 1 January 2018 to 31 December 2020. Patient demographics, distribution of disease spectrum, results of etiological examinations, and the PICU length of stay (LOS) were compared during the COVID-19 period (2020) and the previous years (2018 and 2019). Results: In 2020, the number of PICU admissions was 46.8 and 47.8% lower than that in 2018 and 2019, respectively. There were significant differences in the number of patients in PICU among different age groups, and these differences were mainly found in children aged <4 years and older than 14 years. The percentage of the number of patients in PICU with respiratory diseases decreased significantly, while those with hematological diseases, poisoning, and rare diseases increased significantly. Moreover, the number of patients with rare diseases increased significantly, while the number of patients with mitochondrial diseases exceeded that of those with autoimmune encephalitis. The PICU LOS in 2020 was higher than that observed in 2018 and 2019, indicating that the changes in the PICU disease spectrum did not directly affect the PICU LOS. Etiological examinations revealed that during the COVID-19 period, the number of patients in PICU with bacterial infections increased, and those with viral infections decreased, although not statistically significant. Conclusions: A striking decrease in the number of PICU admissions was observed during the COVID-19 outbreak, which caused a significant change in the PICU disease spectrum. Changes in the number and characteristics of patients admitted to PICUs should be considered for facilitating the effective working of PICUs during the COVID-19 pandemic.