Recently, the research team lead by Prof. Fangrong Yan from the School of Science of China Pharmaceutical University, together with the medical institutions (i.e., The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School and The First Affiliated Hospital of Soochow University) published significant research, titled Clinical Course and Outcomes of 344 Intensive Care Patients with COVID-19, in one of the top authoritative medical journals in the field of severe respiratory medicine—American Journal of Respiratory and Critical Care Medicine (IF 16.49). Prof. Yan and his colleagues reported in detail the course, clinical outcomes and potential risk factors of 344 intensive care patients with COVID-19. Dr. Yang Wang (Department of Radiology, Drum Tower Hospital Affiliated to Nanjing University), and Dr. Xiaofan Lu (Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University) are co-first authors of this study. Dr. Yongsheng Li (Chief Physician of the Department of Intensive Medicine, Wuhan Tongji Hospital), Dr. Jun Wang (Deputy Chief Physician of the Department of Intensive Medicine, The First Affiliated Hospital of Suzhou University) and Prof. Yan are the co-corresponding authors of this article.
The abovementioned study is by far a single-centered, retrospective, observational cohort study involving the largest number of intensive care patients, which included a total of 344 severe or critically ill patients who were diagnosed with COVID-19 and were treated in eight intensive care wards from January 25 to February 25, 2020 in Tongji Hospital, Wuhan, China. The study reported in detail the epidemiological and clinical characteristics, laboratory findings, radiologic manifestations, treatment and care of patients, and also reported the clinical course and the 28-day clinical outcome; potential prognostic risks actors were also inferred statistically. The study showed that elderly patients with underlying diseases have a higher mortality rate and their conditions required to be strictly managed; continuous monitoring of the ratio of SpO2/FiO2, as well as periodic measurement of lymphocyte counts and inflammatory indicators, are specifically useful for the management of COVID-19. Meanwhile, in view of the surge in outpatient consultations in various countries during the epidemic, compared with the traditional arterial blood oxidation index (PaO2/FiO2), the non-invasive SpO2/FiO2 ratio can be used to quickly and flexibly screen potential infection and can serve as biomarker for measuring the severity of the disease.
Additionally, Prof. Yan’s team has cooperated closely with many medical institutions during the epidemic, resulting in other two high-quality researches that have been published in Critical Care (IF 6.4). To be specific, a study focusing on intensive care patients defined four prognostic subtypes using statistical clustering models, and each subtype showed a stepwise distribution in age, respiratory condition and inflammatory indicators. Such classification could help in better triage, allowing for a more rational allocation of scarce medical resources in a resource constrained environment. Another single-centered, retrospective case-control study reported that adjuvant glucocorticoid therapy in addition to antiviral therapy could pose limited effect to overall survival of critically ill patients with COVID-19, but given the adverse effects corticosteroid therapy must be commenced with caution, and prudent dosage should be promoted under certain circumstances.
It is reported that as early as this outbreak, Prof. Yan’s team and radiology department of Nanjing Drum Tower Hospital have cooperated for many years. U-HAPPY CT, an intelligent chest CT scanning system they developed, also played an important role of isolated automatic scanning and early triage in this epidemic. Such technology has been published in EbioMedicine (IF 6.8).
The abovementioned researches were funded by the National Key R&D Program of China (2019YFC1711000), the National Natural Science Foundation of China (81973145), the “Double First-Class” University Project (CPU2018GY09) and other funding projects.