Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient cases

Abstract

Coronavirus disease 2019 (COVID-19) is now pandemic worldwide and has heavily overloaded hospitals in Wuhan City, China during the time between late January and February. We reported the clinical features and therapeutic characteristics of moderate COVID-19 cases in Wuhan that were treated via the integration of traditional Chinese medicine (TCM) and Western medicine. We collected electronic medical record (EMR) data, which included the full clinical profiles of patients, from a designated TCM hospital in Wuhan. The structured data of symptoms and drugs from admission notes were obtained through an information extraction process. Other key clinical entities were also confirmed and normalized to obtain information on the diagnosis, clinical treatments, laboratory tests, and outcomes of the patients. A total of 293 COVID-19 inpatient cases, including 207 moderate and 86 (29.3%) severe cases, were included in our research. Among these cases, 238 were discharged, 31 were transferred, and 24 (all severe cases) died in the hospital. Our COVID-19 cases involved elderly patients with advanced ages (57 years on average) and high comorbidity rates (61%). Our results reconfirmed several well-recognized risk factors, such as age, gender (male), and comorbidities, as well as provided novel laboratory indications (e.g., cholesterol) and TCM-specific phenotype markers (e.g., dull tongue) that were relevant to COVID-19 infections and prognosis. In addition to antiviral/antibiotics and standard supportive therapies, TCM herbal prescriptions incorporating 290 distinct herbs were used in 273 (93%) cases. The cases that received TCM treatment had lower death rates than those that did not receive TCM treatment (17/273 = 6.2% vs. 7/20 = 35%, P = 0.0004 for all cases; 17/77 = 22% vs. 7/9 = 77.7%, P = 0.002 for severe cases). The TCM herbal prescriptions used for the treatment of COVID-19 infections mainly consisted of Pericarpium Citri Reticulatae, Radix Scutellariae, Rhizoma Pinellia, and their combinations, which reflected the practical TCM principles (e.g., clearing heat and dampening phlegm). Lastly, 59% of the patients received treatment, including antiviral, antibiotics, and Chinese patent medicine, before admission. This situation might have some effects on symptoms, such as fever and dry cough. By using EMR data, we described the clinical features and therapeutic characteristics of 293 COVID-19 cases treated via the integration of TCM herbal prescriptions and Western medicine. Clinical manifestations and treatments before admission and in the hospital were investigated. Our results preliminarily showed the potential effectiveness of TCM herbal prescriptions and their regularities in COVID-19 treatment.

Newly Reported Studies on the Increase in Gastrointestinal Symptom Prevalence with COVID-19 Infection: A Comprehensive Systematic Review and Meta-Analysis

“…In a Chinese meta-analysis including 6686 patients, the reported PPE of the anorexia symptom was the same as that in this study, 21% [ 133 ]. Usage of experimental drugs and herbal medicine against COVID–19 infections might be a possible explanation for the higher rate of anorexia symptom PPE values [ 136 ].…”

Prospective: Evolution of Chinese Medicine to Treat COVID-19 Patients in China

“…Dioscorea polystachya Turcz., tuber are included to relieve gastrointestinal symptoms in COVID-19 patients, such as abdominal distention, loss of appetite, and diarrhea. Glycyrrhiza glabra L., root and rhizome, raw or honeyed and Dioscorea polystachya Turcz., tuber belong to "Bu-Yi" herbs in TCM and are used to treat patients with fatigueone of the main symptoms in COVID-19 patients (Li et al, 2020b), known to worsen throughout COVID-19 disease progression and to hinder patient recovery. In summary, in addition to reducing lung damage, LCDD may reduce other tissue damage, such as in the kidney, liver, heart and brain.…”

Severe Acute Respiratory Syndrome Coronavirus-2 Induces Cytokine Storm and Inflammation During Coronavirus Disease 19: Perspectives and Possible Therapeutic Approaches

“…The application of the traditional Chinese medicine for the treatment of SARS-CoV-2 is currently based on the treatments used for SARS-CoV, thanks to their similarities (Gong et al, 2008;Nguyen et al, 2012). A retrospective observational study carried out in 293 patients affected by COVID-19 showed that the prescription of common herbs used in folk medicine may be considered as an integrative approach for COVID-19 management, since some popularly used drugs, such as moxifloxacin, oseltamivir, and Arbidol, are not always effective in reducing severe symptoms (Shu et al, 2020). However, since COVID-19 is a complex clinical disease that is often complicated by severe disorders, as clotting activation, rapid degeneration of parenchyma, and organ failure, additional studies will be requested to confirm the efficacy of traditional medicine approach alone or in combination with other drugs.…”

“…Among the other antiviral strategies, umifenovir (Arbidol) is a new antiviral option approved in China for the management of COVID-19: it prevents virus entry by binding to hemagglutinin ( Aktas et al, 2020 ). However, clinical studies on umifenovir showed that the administration of umifenovir alone was ineffective, whereas the combination with other antivirals might ameliorate viral clearance and improve lung damage ( Chen et al, 2020 ; Song et al, 2020 ).…”