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0 0.5 1 1.5 2+ Hospitalization time 14% Improvement Relative Risk Time to clinical improve.. 14% Time to viral- 17% Probiotics for COVID-19  Zhang et al.  LATE TREATMENT Is late treatment with probiotics beneficial for COVID-19? Retrospective 300 patients in China Shorter hospitalization (p=0.009) and faster recovery (p=0.022) Zhang et al., Therapeutic Advances in .., Aug 2021 Favors probiotics Favors control

Probiotics use is associated with improved clinical outcomes among hospitalized patients with COVID-19

Zhang et al., Therapeutic Advances in Gastroenterology, doi:10.1177/17562848211035670
Aug 2021  
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Retrospective 375 patients in China, 179 treated with probiotics (Bifidobacterium, Lactobacillus, and Enterococcus), showing improved clinical outcomes with treatment.
The immune effects of probiotics are strain-specific.
hospitalization time, 13.6% lower, relative time 0.86, p = 0.009, treatment 150, control 150, PSM.
time to clinical improvement, 14.3% lower, relative time 0.86, p = 0.02, treatment 150, control 150, PSM.
time to viral-, 16.7% lower, relative time 0.83, p < 0.001, treatment 150, control 150, PSM.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Zhang et al., 4 Aug 2021, retrospective, China, peer-reviewed, 14 authors.
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Probiotics use is associated with improved clinical outcomes among hospitalized patients with COVID-19
Lina Zhang, Huanqin Han, Xuan Li, Caozhen Chen, Xiaobing Xie, Guomei Su, Shicai Ye, Cuili Wang, Qing He, Fang Wang, Fang Huang, Zhaoqin Wang, Jiayuan Wu, Tianwen Lai
Therapeutic Advances in Gastroenterology, doi:10.1177/17562848211035670
Background and aims: Currently, there are no definitive therapies for coronavirus disease 2019 (COVID-19). Gut microbial dysbiosis has been proved to be associated with COVID-19 severity and probiotics is an adjunctive therapy for COIVD-19. However, the potential benefit of probiotics in COVID-19 has not been studied. We aimed to assess the relationship of probiotics use with clinical outcomes in patients with COVID-19. Methods: We conducted a propensity-score matched retrospective cohort study of adult patients with COVID-19. Eligible patients received either probiotics plus standard care (probiotics group) or standard care alone (non-probiotics group). The primary outcome was the clinical improvement rate, which was compared among propensity-score matched groups and in the unmatched cohort. Secondary outcomes included the duration of viral shedding, fever, and hospital stay. Results: Among the propensity-score matched groups, probiotics use was related to clinical improvement rates (log-rank p = 0.028). This relationship was driven primarily by a shorter (days) time to clinical improvement [difference, −3 (−4 to −1), p = 0.022], reduction in duration of fever [−1.0 (−2.0 to 0.0), p = 0.025], viral shedding [−3 (−6 to −1), p < 0.001], and hospital stay [−3 (−5 to −1), p = 0.009]. Using the Cox model with time-varying exposure, use of probiotics remained independently related to better clinical improvement rate in the unmatched cohort. Conclusion: Our study suggested that probiotics use was related to improved clinical outcomes in patients with COVID-19. Further studies are required to validate the effect of probiotics in combating the COVID-19 pandemic.
Author contributions Contributors: LNZ, HQH, XL, and CZC served as co-first authors. TWL, JYW, and ZQW served as co-corresponding authors. TWL and ZQW designed the study, interpreted the results, the accuracy of the data analysis, and drafted the manuscript. LNZ, JYW, XL, and HQH contributed to data collection, data analysis, and data interpretation. XBX, CLW, SCY, QH, FW, FH, and GMS contributed to literature search and data collection. All authors approved the final version of the manuscript. Conflict of interest statement The authors declare that there is no conflict of interest. Data availability statement The data supporting the findings of this study are available from the corresponding author upon reasonable request. Funding ORCID iD Tianwen Lai Supplemental material Supplemental material for this article is available online.
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Late treatment
is less effective
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