{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:04:41Z","timestamp":1753891481934,"version":"3.41.2"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T00:00:00Z","timestamp":1615334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> The coronavirus disease 2019 (COVID-19) has swept through the world at a tremendous speed, and there is still limited data available on the treatment for COVID-19. The mortality of severely and critically ill COVID-19 patients in the Optical Valley Branch of Tongji Hospital was low. We aimed to analyze the available treatment strategies to reduce mortality.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> In this retrospective, single-center study, we included 1,106 COVID-19 patients admitted to the Optical Valley Branch of Tongji Hospital from February 9 to March 9, 2020. Cases were analyzed for demographic and clinical features, laboratory data, and treatment methods. Outcomes were followed up until March 29, 2020.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Inflammation-related indices (hs-CRP, ESR, serum ferritin, and procalcitonin) were significantly higher in severe and critically ill patients than those in moderate patients. The levels of cytokines, including IL-6, IL2R, IL-8, and TNF-\u03b1, were also higher in the critical patients. Incidence of acute respiratory distress syndrome (ARDS) in the severely and critically ill group was 23.0% (99\/431). Sixty-one patients underwent invasive mechanical ventilation. The correlation between SpO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> and PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> was confirmed, and the cut-off value of SpO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> related to survival was 134.43. The mortality of patients with low SpO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> (&amp;lt;134.43) at intubation was higher than that of patients with high SpO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> (&amp;gt;134.43) (72.7 vs. 33.3%). Among critical patients, the application rates of glucocorticoid therapy, continuous renal replacement therapy (CRRT), and anticoagulation treatment reached 55.2% (238\/431), 7.2% (31\/431), and 37.1% (160\/431), respectively. Among the intubated patients, the application rates of glucocorticoid therapy, CRRT, and anticoagulation treatment were respectively 77.0% (47\/61), 54.1% (33\/61), and 98.4% (60\/61).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> No vaccines or specific antiviral drugs for COVID-19 have been shown to be sufficiently safe and effective to date. Comprehensive treatment including ventilatory support, multiple organ function preservation, glucocorticoid use, renal replacement therapy, anticoagulation, and restrictive fluid management was the main treatment strategy. Early recognition and intervention, multidisciplinary collaboration, multi-organ function support, and personalized treatment might be the key for reducing mortality.<\/jats:p>","DOI":"10.3389\/fmed.2021.582764","type":"journal-article","created":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T04:33:25Z","timestamp":1615350805000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Optimizing Management to Reduce the Mortality of COVID-19: Experience From a Designated Hospital for Severely and Critically Ill Patients in China"],"prefix":"10.3389","volume":"8","author":[{"given":"Wei","family":"Zhu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huaqiu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeyang","family":"Ding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhuo","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yajun","family":"Ruan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huan","family":"Feng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ganxun","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fan","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ning","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiangang","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhixiang","family":"Wen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianping","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bixiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daowen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhouping","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jihong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,3,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A novel coronavirus from patients with pneumonia in China, 2019","volume":"382","author":"Zhu","year":"2020","journal-title":"N Engl J Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA"},{"key":"B4","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1001\/jamainternmed.2020.0994","article-title":"Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China","volume":"180","author":"Wu","year":"2020","journal-title":"JAMA Internal Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA"},{"key":"B6","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological L, and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study","volume":"395","author":"Chen","year":"2020","journal-title":"Lancet"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1001\/jama.2020.5394","article-title":"Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the lombardy region, Italy","volume":"323","author":"Grasselli","year":"2020","journal-title":"JAMA."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2052","DOI":"10.1001\/jama.2020.6775","article-title":"Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area","volume":"323","author":"Richardson","year":"2020","journal-title":"JAMA."},{"key":"B9","doi-asserted-by":"publisher","first-page":"m1966","DOI":"10.1136\/bmj.m1966","article-title":"Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study","volume":"369","author":"Petrilli","year":"2020","journal-title":"BMJ."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1016\/S0140-6736(20)30744-3","article-title":"Fangcang shelter hospitals: a novel concept for responding to public health emergencies","volume":"395","author":"Chen","year":"2020","journal-title":"Lancet."},{"key":"B11","unstructured":"Health Commission of Hubei Province: Epidemic situation of COVID-19 in Hubei province"},{"key":"B12","unstructured":"National Health Commission of China, Guidance for COVID-19: Prevention, Control, Diagnosis and Management (Version 7.0)"},{"key":"B13","unstructured":"Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection issuspected: interim guidance"},{"key":"B14","doi-asserted-by":"publisher","first-page":"m1091","DOI":"10.1136\/bmj.m1091","article-title":"Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study","volume":"368","author":"Chen","year":"2020","journal-title":"BMJ."},{"key":"B15","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics."},{"key":"B16","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1016\/S0140-6736(20)30361-5","article-title":"On the use of corticosteroids for 2019-nCoV pneumonia","volume":"395","author":"Shang","year":"2020","journal-title":"Lancet."},{"key":"B17","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1007\/s11684-020-0774-9","article-title":"Organ function support in patients with coronavirus disease 2019: tongji experience","volume":"14","author":"Li","year":"2020","journal-title":"Front Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003412","article-title":"Clinical pathology of critical patient with novel coronavirus pneumonia (COVID-19)","author":"Luo","year":"2020","journal-title":"Pathol Pathobiol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1016\/S2213-2600(20)30076-X","article-title":"Pathological findings of COVID-19 associated with acute respiratory distress syndrome","volume":"8","author":"Xu","year":"2020","journal-title":"Lancet Respiratory Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.1001\/jama.2020.4914","article-title":"Management of critically ill adults with COVID-19","volume":"323","author":"Poston","year":"2020","journal-title":"JAMA"},{"key":"B22","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1164\/rccm.201503-0584OC","article-title":"Hospital incidence and outcomes of the acute respiratory distress syndrome using the kigali modification of the berlin definition","volume":"193","author":"Riviello","year":"2016","journal-title":"Am J Respiratory Critical Care Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"28","DOI":"10.15171\/jcvtr.2014.06","article-title":"Comparison of the spo2\/fio2 ratio and the pao2\/fio2 ratio in patients with acute lung injury or acute respiratory distress syndrome","volume":"7","author":"Bilan","year":"2015","journal-title":"J Cardiovasc Thoracic Res."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1430","DOI":"10.1164\/rccm.202003-0736LE","article-title":"Clinical course and outcomes of 344 intensive care patients with COVID-19","volume":"201","author":"Wang","year":"2020","journal-title":"Am J Respiratory Critical Care Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/S0140-6736(20)30628-0","article-title":"COVID-19: consider cytokine storm syndromes and immunosuppression","volume":"395","author":"Mehta","year":"2020","journal-title":"Lancet."},{"key":"B26","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/S0140-6736(20)30317-2","article-title":"Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury","volume":"395","author":"Russell","year":"2020","journal-title":"Lancet"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1001\/jama.2020.16761","article-title":"& Le Gouge A. Effect of hydrocortisone on 21-day mortality or respiratory support among critically ill patients with COVID-19: a randomized clinical trial","volume":"324","author":"Dequin","year":"2020","journal-title":"JAMA."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.1001\/jama.2020.17023","article-title":"Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis[J]","volume":"324","author":"Sterne","year":"2020","journal-title":"JAMA"},{"key":"B29","doi-asserted-by":"publisher","first-page":"NEJMoa2021436","DOI":"10.1056\/nejmoa2021436","article-title":"Dexamethasone in hospitalized patients with covid-19 - preliminary report","volume":"17","author":"Horby","year":"2020","journal-title":"N Engl J Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1001\/jama.2020.17022","article-title":"Effect of hydrocortisone on mortality organ support in patients with severe COVID-19: The REMAP-CAP COVID-19 corticosteroid domain randomized clinical trial","volume":"324","year":"2020","journal-title":"JAMA"},{"key":"B31","doi-asserted-by":"publisher","first-page":"9852073","DOI":"10.1155\/2016\/9852073","article-title":"Cytokine reduction in the setting of an ards-associated inflammatory response with multiple organ failure","volume":"2016","author":"Trager","year":"2016","journal-title":"Case Reports Critical Care."},{"key":"B32","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respiratory Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"959","DOI":"10.2217\/imt-2016-0020","article-title":"Immunotherapeutic implications of IL-6 blockade for cytokine storm","volume":"8","author":"Tanaka","year":"2016","journal-title":"Immunotherapy."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1016\/S0140-6736(06)68474-2","article-title":"Risk of deep vein thrombosis and pulmonary embolism after acute infection in a community setting","volume":"367","author":"Smeeth","year":"2006","journal-title":"Lancet."},{"key":"B35","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1038\/nm.2184","article-title":"Reciprocal coupling of coagulation and innate immunity via neutrophil serine proteases","volume":"16","author":"Massberg","year":"2010","journal-title":"Nat Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.jvsv.2018.08.010","article-title":"Empirical systemic anticoagulation is associated with decreased venous thromboembolism in critically ill influenza A H1N1 acute respiratory distress syndrome patients","volume":"7","author":"Obi","year":"2019","journal-title":"J Vasc Surg Venous Lymphatic Disorders."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.582764\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T04:33:38Z","timestamp":1615350818000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.582764\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,10]]},"references-count":36,"alternative-id":["10.3389\/fmed.2021.582764"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.582764","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2021,3,10]]},"article-number":"582764"}}