Association between early treatment with Qingfei Paidu decoction and favorable clinical outcomes in patients with COVID-19: A retrospective multicenter cohort study

Abstract

The coronavirus disease 2019 (COVID-19) epidemic has been almost controlled in China under a series of policies, including "early diagnosis and early treatment". This study aimed to explore the association between early treatment with Qingfei Paidu decoction (QFPDD) and favorable clinical outcomes. In this retrospective multicenter study, we included 782 patients (males, 56 %; median age 46) with confirmed COVID-19 from 54 hospitals in nine provinces of China, who were divided into four groups according to the treatment initiation time from the first date of onset of symptoms to the date of starting treatment with QFPDD. The primary outcome was time to recovery; days of viral shedding, duration of hospital stay, and course of the disease were also analyzed. Compared with treatment initiated after 3 weeks, early treatment with QFPDD after less than 1 week, 1-2 weeks, or 2-3 weeks had a higher likelihood of recovery, with adjusted hazard ratio (HR) (95 % confidence interval [CI]) of 3.81 (2.65-5.48), 2.63 (1.86-3.73), and 1.92 (1.34-2.75), respectively. The median course of the disease decreased from 34 days to 24 days, 21 days, and 18 days when treatment was administered early by a week (P < 0.0001). Treatment within a week was related to a decrease by 1-4 days in the median duration of hospital stay compared with late treatment (P<0.0001). In conclusion, early treatment with QFPDD may serve as an effective strategy in controlling the epidemic, as early treatment with QFPDD was associated with favorable outcomes, including faster recovery, shorter time to viral shedding, and a shorter duration of hospital stay. However, further multicenter, prospective studies with a larger sample size should be conducted to confirm the benefits of early treatment with QFPDD.

Keywords: COVID-19; Early treatment; Qingfei Paidu decoction.

Graphical abstract

Fig. 1

Patient inclusion/exclusion criteria.

Fig. 2

Kaplan-Meier plot for the primary outcome of time to recovery in patients infected with coronavirus disease 2019 by time from the onset of symptoms to treatment groups with 95 % CIs. Abbreviations: COVID-19, coronavirus disease 2019; Adj., adjusted; CI, confidence interval; HR, hazard ratio. The primary outcome was time to events, which was defined as the days from the onset of COVID-19 disease symptoms to clinical effectiveness for the treatment. If no event had occurred at the time of the last record, the patient’s survival time was censored at that time. Covariates were selected by the stepwise selection method (P = 0.05) and then were used to estimate propensity scores in multivariable logistic regression. HR and its 95 % CI were calculated using the Cox proportional risk model adjusted by propensity score and other significant covariates in the univariate analysis.

Fig. 3

Daily temperature (℃) variations of patients infected with coronavirus disease 2019 by time from the onset of symptoms to treatment during a 14-day hospitalization period. Data are expressed as the Mean ± SD. Abbreviation: SD, standard deviation.