Evaluation and Treatment of Severe SARS-CoV-2 Pneumonia: A Scoping Review

PurposeSevere SARS-CoV-2 pneumonia remains incompletely understood. We aimed to summarize current evidence regarding clinical features, laboratory findings, and treatment of severe pneumonia. MethodsOnline databases were searched from December 1, 2019, to April 15, 2020 related to SARS-CoV-2. The titles and abstracts in English or Chinese for articles were screened. Studies containing more than 10 adult patients with severe pneumonia and presenting data on clinical features and laboratory findings were selected and extracted independently by two reviewers. ResultsWe identified a total of 13 articles including one from Italy representing the majority of cases, and the remainder from China. Over the 2,129 severe pneumonia in these 13 articles, the mean ages ranged from 49 to 64 years. Patients typically presented with hypertension as the most common comorbid factor, fever as the most common symptom, and acute respiratory distress syndrome as the most common complication. As compared to non-severe pneumonia, severe pneumonia featured lower counts of lymphocytes, CD8+ and CD4+ T cells, and higher levels of D-dimer, lactate dehydrogenase, IL-6 and IL-10. There is a lack of evidence for using antivirals, and a debate on using corticosteroids in treatment. ConclusionsThis is the first systematic summarization of the aspects of severe pneumonia. Older age, comorbidities, laboratory findings might be the predisposing factors of disease severity. Multicenter- and large population-designed studies, with confounding controlled and long enough to accommodate follow-ups, are urgently required to provide the guidance to disease management.