ABSTRACT
Background: Corticosteroids were recommended by guidelines in severe or critical COVID -19 patients likely to have acute respiratory distress syndrome. In the treatment strategies of COVID -19 in China, corticosteroids were generally combined with some traditional Chinese medicine, especially Lianhua Qingwen Capsule (LHQW). We aimed to investigate the correlation between dexamethasone with or without LHQW and the nucleic acid negative conversion in severe patients with COVID-19. Methods: : The clinical course and nucleic acid negative conversion time of 452 consecutive symptomatic COVID-19 patients admitted to the west campus of Union Hospital in Wuhan from January 31, 2020, to March 13, 2020, were evaluated retrospectively. Results: : The duration of virus RNA from positive to negative in the participants was 28 days (interquartile range 21-34 days). Of the 452 patients, 105 (23.23%) subjects received dexamethasone, and 347 (76.77%) did not. Among patients receiving LHQW treatment, the nucleic acid negative conversion time in the dexamethasone group was shorter than that in the no dexamethasone group (𝛽, -4.77; 95% CI, -9.41, -0.12). Although among those who were receiving no LHQW treatment, the effect on shortening nucleic acid negative conversion time of dexamethasone was not observed (𝛽, 5.37; 95% CI,-4.88, 15.62; p interaction = 0.038). Additional multivariable propensity-score analyses yielded consistent results with the unmatched participants (β, -8.61; 95% CI, -16.73, -0.50). Conclusions: ： In patients hospitalized with COVID-19, the use of dexamethasone resulted in shortening nucleic acid negative conversion time among those who were receiving LHQW, suggesting that LHQW synergic with dexamethasone accelerated the SARS-CoV-2 clearance in severe patients. Trial registration： ECUH 2020-0212, a retrospective study.
Subject(s)
COVID-19 , Conversion Disorder , Respiratory Distress SyndromeABSTRACT
Object: A recently developing pneumonia called COVID-19 which caused by SARS-CoV-2 has quickly spread across the world. Lymphopenia and a proinflammatory cytokine storm frequently happened in severe COVID-19 patients. But no specific immunomodulate therapy on COVID-19 had been reported. In this retrospect case control study, we observed the potential therapeutic effect of recombinant human interleukin-2 (rIL-2) on severe COVID-19 patients in a hospital in Wuhan, China. Methods: Fifty nine severe cases with COVID-19 admitted in hospital from January 29, 2020 to February 29, 2020 were included in this study. Twenty patients received a one-week to 10 days subcutaneous injection of the recombinant human interleulin-2 1 million IU per day other than regular treatment were classified as rIL-2 group. Twenty from thirty nine patients with regular treatment without intervention of rIL-2 were matched as the control group. Clinical characteristic such as age, gender, symptoms, signs, laboratory data and comorbidities were paired in these two groups. Changes of lymphocytes counts, IL-6 and C- reactive protein (CRP) before and after rIL-2 treatment and differences between rIL-2 group and non-rIL-2 group were analyzed.Results: There were a clearly visible increasing in lymphocyte counts and a decreasing in CRP level in non rIL-2 group and rIL-2 group. The difference of the change of lymphocyte counts were significant in rIL-2 group and non-rIL-2 group (p<0.01). Though CRP decreased more in rIL-2 group, it did not show a significant difference between the two groups (p>0.05).Conclusion: RIL-2 might be a prospective adjuvant therapy for severe COVID-19 patients by increasing lymphocytes number.