scholarly journals Ruxolitinib versus dexamethasone in hospitalized adults with COVID-19: multicenter matched cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
O. V. Stanevich ◽  
D. S. Fomina ◽  
I. G. Bakulin ◽  
S. I. Galeev ◽  
E. A. Bakin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Failure ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Hospitalized Patients ◽  
High Fever ◽  
Cytokine Therapy ◽  
Fatality Rate ◽  
Matched Cohort ◽  
Matched Cohort Study

Abstract Background Several anti-cytokine therapies were tested in the randomized trials in hospitalized patients with severe acute respiratory syndrome coronavirus 2 infection (COVID-19). Previously, dexamethasone demonstrated a reduction of case-fatality rate in hospitalized patients with respiratory failure. In this matched control study we compared dexamethasone to a Janus kinase inhibitor, ruxolitinib. Methods The matched cohort study included 146 hospitalized patients with COVID-19 and oxygen support requirement. The control group was selected 1:1 from 1355 dexamethasone-treated patients and was matched by main clinical and laboratory parameters predicting survival. Recruitment period was April 7, 2020 through September 9, 2020. Results Ruxolitinib treatment in the general cohort of patients was associated with case-fatality rate similar to dexamethasone treatment: 9.6% (95% CI [4.6–14.6%]) vs 13.0% (95% CI [7.5–18.5%]) respectively (p = 0.35, OR = 0.71, 95% CI [0.31–1.57]). Median time to discharge without oxygen support requirement was also not different between these groups: 13 vs. 11 days (p = 0.13). Subgroup analysis without adjustment for multiple comparisons demonstrated a reduced case-fatality rate in ruxolitnib-treated patients with a high fever (≥ 38.5 °C) (OR 0.33, 95% CI [0.11–1.00]). Except higher incidence of grade 1 thrombocytopenia (37% vs 23%, p = 0.042), ruxolitinib therapy was associated with a better safety profile due to a reduced rate of severe cardiovascular adverse events (6.8% vs 15%, p = 0.025). For 32 patients from ruxolitinib group (21.9%) with ongoing progression of respiratory failure after 72 h of treatment, additional anti-cytokine therapy was prescribed (8–16 mg dexamethasone). Conclusions Ruxolitinib may be an alternative initial anti-cytokine therapy with comparable effectiveness in patients with potential risks of steroid administration. Patients with a high fever (≥ 38.5 °C) at admission may potentially benefit from ruxolitinib administration. Trial registration The Ruxolitinib Managed Access Program (MAP) for Patients Diagnosed With Severe/Very Severe COVID-19 Illness NCT04337359, CINC424A2001M, registered April, 7, 2020. First participant was recruited after registration date

scholarly journals Comparison of 30-day case-fatality rate between dialysis and transplant Covid-19 patients: a propensity score matched cohort study

2021 ◽  
Author(s):  
Tainá Veras de Sandes-Freitas ◽  
Luís Gustavo Modelli de Andrade ◽  
Lucio Roberto Requião Moura ◽  
Marina Pontello Cristelli ◽  
José Osmar Medina-Pestana ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Fatality Rate ◽  
Matched Cohort ◽  
Day Case ◽  
Matched Cohort Study

scholarly journals COVID-19 severity in hospitalized patients with asthma: A matched cohort study

2020 ◽  
Author(s):  
Lacey B. Robinson ◽  
Xiaoqing Fu ◽  
Ingrid V. Bassett ◽  
Virginia A. Triant ◽  
Andrea S. Foulkes ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospitalized Patients ◽  
Matched Cohort ◽  
Matched Cohort Study

scholarly journals Severe Acute Respiratory Syndrome Coronavirus 2 Lethality Did not Change Over Time in Two Italian Provinces

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Maria Elena Flacco ◽  
Cecilia Acuti Martellucci ◽  
Francesca Bravi ◽  
Giustino Parruti ◽  
Alfonso Mascitelli ◽  
...  
Keyword(s):  
Cohort Study ◽  
Severe Acute Respiratory Syndrome ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Fatality Rate ◽  
Day Case ◽  
Italian Provinces ◽  
Over Time

Abstract This retrospective cohort study included all the subjects diagnosed with severe acute respiratory syndrome coronavirus 2 infection (n = 2493) in 2 Italian provinces. Two hundred fifty-eight persons died, after a median of 14.0 ± 11.0 days. Adjusting for age, gender, and main comorbidities, the ≥28-day case-fatality rate did not decrease from March to April 2020 (adjusted hazard ratio, 0.93; P = .6).

Excess Mortality Among Hospitalized Patients With Hypopituitarism—A Population-Based, Matched-Cohort Study

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Fahim Ebrahimi ◽  
Alexander Kutz ◽  
Ulrich Wagner ◽  
Ben Illigens ◽  
Timo Siepmann ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Excess Mortality ◽  
Population Based ◽  
Hospitalized Patients ◽  
Matched Cohort ◽  
Prolonged Length ◽  
Matched Cohort Study ◽  
Increased Risk

Abstract Context Patients with hypopituitarism face excess mortality in the long-term outpatient setting. However, associations of pituitary dysfunction with outcomes in acutely hospitalized patients are lacking. Objective The objective of this work is to assess clinical outcomes of hospitalized patients with hypopituitarism with or without diabetes insipidus (DI). Design, Setting, and Patients In this population-based, matched-cohort study from 2012 to 2017, hospitalized adult patients with a history of hypopituitarism were 1:1 propensity score–matched with a general medical inpatient cohort. Main Outcome Measures The primary outcome was in-hospital mortality. Secondary outcomes included all-cause readmission rates within 30 days and 1 year, intensive care unit (ICU) admission rates, and length of hospital stay. Results After matching, 6764 cases were included in the study. In total, 3382 patients had hypopituitarism and of those 807 (24%) suffered from DI. All-cause in-hospital mortality occurred in 198 (5.9%) of patients with hypopituitarism and in 164 (4.9%) of matched controls (odds ratio [OR] 1.32, [95% CI, 1.06-1.65], P = .013). Increased mortality was primarily observed in patients with DI (OR 3.69 [95% CI, 2.44-5.58], P < .001). Patients with hypopituitarism had higher ICU admissions (OR 1.50 [95% CI, 1.30-1.74], P < .001), and faced a 2.4-day prolonged length of hospitalization (95% CI, 1.94–2.95, P < .001) compared to matched controls. Risk of 30-day (OR 1.31 [95% CI, 1.13-1.51], P < .001) and 1-year readmission (OR 1.29 [95% CI, 1.17-1.42], P < .001) was higher among patients with hypopituitarism as compared with medical controls. Conclusions Patients with hypopituitarism are highly vulnerable once hospitalized for acute medical conditions with increased risk of mortality and adverse clinical outcomes. This was most pronounced among those with DI.

scholarly journals Impact of the inclusion of an aminoglycoside to the initial empirical antibiotic therapy for Gram-negative bloodstream infections in hematological neutropenic patients: a propensity-matched cohort study (AMINOLACTAM study)

2021 ◽  
Author(s):  
A Albasanz-Puig ◽  
C Gudiol ◽  
P Puerta-Alcalde ◽  
C. M. Ayaz ◽  
M Machado ◽  
...  
Keyword(s):  
Cohort Study ◽  
Combination Therapy ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Combination Group ◽  
Fatality Rate ◽  
Day Case ◽  
Gram Negative ◽  
Therapy Regimen ◽  
Neutropenic Patients

Objective: To test the hypothesis that the addition of an aminoglycoside to a ß-lactam antibiotic could provide better outcomes than ß-lactam monotherapy for the initial empirical treatment of hematological neutropenic patients with subsequently documented Gram-negative bacilli (GNB) bloodstream infection (BSI). Methods: Multinational, retrospective, cohort study of GNB BSI episodes in hematological neutropenic patients in six centers (2010–2017). Combination therapy (ß-lactam plus aminoglycoside) was compared to ß-lactam monotherapy. The primary endpoint was the case-fatality rate assessed at 7 and 30-days from BSI onset. Secondary endpoints were nephrotoxicity and persistent BSI. Propensity score (PS) matching was performed. Results: Among 542 GNB BSI episodes, 304 (56%) were initially treated with combination therapy, with cefepime plus amikacin being most common (158/304, 52%). Overall, Escherichia coli (273/304, 50.4%) was the main etiological agent, followed by Pseudomonas aeruginosa, which predominated in the combination group [76/304 (25%) vs. 28/238 (11.8%); p<0.001]. Multidrug resistance rates were similar between groups [83/294 (28.2%) vs. 63/233 (27%); p=0.95]. In the multivariate analysis combination therapy was associated with lower 7-day case-fatality rate (OR 0.37, 95%CI 0.14-0.91;p=0.035) with a tendency towards lower mortality at 30 days (OR 0.56, 95%CI 0.29–1.08;p=0.084). After PS-matching, these differences remained for the 7-day case-fatality rate (OR 0.33, 95%CI 0.13–0.82;p=0.017). In addition, aminoglycoside use was not significantly associated with renal function impairment (OR 1.12, 95%CI 0.26–4.87;p=0.9). Conclusions: The addition of an aminoglycoside to the initial empirical therapy regimen for febrile neutropenic hematological patients should be considered.

Sign in / Sign up

Export Citation Format

Share Document