Current Understanding of COVID-19 Clinical Course and Investigational Treatments.
Current Understanding of COVID-19 Clinical Course and Investigational Treatments.
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DOI：
10.3389/fmed.2020.555301
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发表时间：
2020
影响因子：
3.9
通讯作者：
Hernandez MB
中科院分区：
文献类型：
--
作者：
Aguilar RB;Hardigan P;Mayi B;Sider D;Piotrkowski J;Mehta JP;Dev J;Seijo Y;Camargo AL;Andux L;Hagen K;Hernandez MB
重要性：目前，尚无将疾病进展与已建立的病毒水平、临床试验、炎症标志物和研究性治疗方案联系起来的统一框架。目的：建立标准的治疗方法可能需要数周或数月的时间。鉴于COVID-19的发病率和死亡率不断上升，本系统综述提出了一种基于对学术文章和临床报告的全面审查的治疗方法。我们的重点是分阶段进展、临床算法和个体化治疗。证据审查：我们遵循Heyn等人提出的质量审查文章的方案。进行文献检索，查找与COVID-19相关的所有相关研究。检索于2020年4月1日至2020年4月13日期间进行，使用以下电子数据库：PubMed（1809年至今）；谷歌学者（1900年至今）；MEDLINE（1946年至今），CINAHL（1937年至今）；Embase（1980年至今）。关键词包括COVID-19、2019-nCov、SARS-CoV-2、SARS-CoV和MERS-CoV，以及疗效、血清转化、微生物学、病理生理学、病毒水平、炎症、生存能力、治疗和药理学等术语。搜索过程中没有语言限制。手动扫描参考文献列表以查找其他研究。结果：在文献检索中找到的文章中，有70篇被纳入本研究（67篇在文章正文中被引用，另外3篇在图中被引用）。这些作品来自中国、日本、台湾、越南、卢旺达、以色列、法国、英国、荷兰、加拿大和美国。大多数文章是队列或案例研究，但我们也借鉴了其他信息，包括医院和诊所指导其工作人员遵循的程序的指南。此外，我们还根据CDC、FDA、IHME、IDSA和Worldometer等组织收集的数据做出了一些决定。没有一个案例研究或队列研究使用了大量的参与者。最大的一组参与者人数少于500人，一些病例研究的患者人数少于30人。然而，文献回顾显示，由于患者临床表现和生存能力的可变性，需要个性化的治疗方案。影响死亡率的因素似乎有很多：患者首次就诊的阶段、先前存在的健康状况、年龄和患者携带的病毒载量。结论及相关性：COVID-19可分为三个不同的阶段，从感染时开始（I期），有时进展为肺部受累（II期，伴或不伴低氧血症），较不常见的是全身性炎症（III期）。除了对疾病进展阶段和诊断测试进行建模外，我们还创建了一个治疗算法，该算法考虑了年龄、合并症、临床表现和疾病进展，以建议药物类别或治疗方式。本文提出了首个基于证据的COVID-19个体化治疗建议。
Importance: Currently, there is no unified framework linking disease progression to established viral levels, clinical tests, inflammatory markers, and investigational treatment options. Objective: It may take many weeks or months to establish a standard treatment approach. Given the growing morbidity and mortality with respect to COVID-19, this systemic review presents a treatment approach based on a thorough review of scholarly articles and clinical reports. Our focus is on staged progression, clinical algorithms, and individualized treatment. Evidence Review: We followed the protocol for a quality review article proposed by Heyn et al.. A literature search was conducted to find all relevant studies related to COVID-19. The search was conducted between April 1, 2020, and April 13, 2020, using the following electronic databases: PubMed (1809 to present); Google Scholar (1900 to present); MEDLINE (1946 to present), CINAHL (1937 to present); and Embase (1980 to present). The keywords used included COVID-19, 2019-nCov, SARS-CoV-2, SARS-CoV, and MERS-CoV, with terms such as efficacy, seroconversion, microbiology, pathophysiology, viral levels, inflammation, survivability, and treatment and pharmacology. No language restriction was placed on the search. Reference lists were manually scanned for additional studies. Findings: Of the articles found in the literature search, 70 were selected for inclusion in this study (67 cited in the body of the manuscript and 3 additional unique references in the Figures). The articles represent work from China, Japan, Taiwan, Vietnam, Rwanda, Israel, France, the United Kingdom, the Netherlands, Canada, and the United States. Most of the articles were cohort or case studies, but we also drew upon other information, including guidelines from hospitals and clinics instructing their staff on procedures to follow. In addition, we based some decisions on data collected by organizations such as the CDC, FDA, IHME, IDSA, and Worldometer. None of the case studies or cohort studies used a large number of participants. The largest group of participants numbered <500 and some case studies had fewer than 30 patients. However, the review of the literature revealed the need for individualized treatment protocols due to the variability of patient clinical presentation and survivability. A number of factors appear to influence mortality: the stage at which the patient first presented for care, pre-existing health conditions, age, and the viral load the patient carried. Conclusion and Relevance: COVID-19 can be divided into three distinct stages, beginning at the time of infection (Stage I), sometimes progressing to pulmonary involvement (Stage II, with or without hypoxemia), and less frequently to systemic inflammation (Stage III). In addition to modeling the stages of disease progression along with diagnostic testing, we have also created a treatment algorithm that considers age, comorbidities, clinical presentation, and disease progression to suggest drug classes or treatment modalities. This paper presents the first evidence-based recommendations for individualized treatment for COVID-19.
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DOI：
10.2183/pjab.93.027
发表时间：
2017
期刊：
Proceedings of the Japan Academy. Series B, Physical and biological sciences
影响因子：
--
作者：
Furuta Y;Komeno T;Nakamura T
通讯作者：
Nakamura T
影响因子：
158.5
作者：
Grein, J.;Ohmagari, N.;Flanigan, T.
通讯作者：
Flanigan, T.
用糖固醇治疗严重的急性呼吸道综合征：广州体验。
影响因子：
9.6
作者：
Chen RC;Tang XP;Tan SY;Liang BL;Wan ZY;Fang JQ;Zhong N
通讯作者：
Zhong N
影响因子：
28.2
作者：
Chen, Jun;Qi, Tangkai;Lu, Hongzhou
通讯作者：
Lu, Hongzhou
影响因子：
7.6
作者：
Caly, Leon;Druce, Julian D;Wagstaff, Kylie M
通讯作者：
Wagstaff, Kylie M