Impact of Pneumococcal Urinary Antigen Testing in COVID-19 Patients: Outcomes from the San Matteo COVID-19 Registry (SMACORE)

Despite low rates of bacterial co-infections, most COVID-19 patients receive antibiotic therapy. We hypothesized that patients with positive pneumococcal urinary antigens (PUAs) would benefit from antibiotic therapy in terms of clinical outcomes (death, ICU admission, and length of stay). The San Matteo COVID-19 Registry (SMACORE) prospectively enrolls patients admitted for COVID-19 pneumonia at IRCCS Policlinico San Matteo, Pavia. We retrospectively extracted the data of patients tested for PUA from October to December 2020. Demographic, clinical, and laboratory data were recorded. Of 469 patients, 42 tested positive for PUA (8.95%), while 427 (91.05%) tested negative. A positive PUA result had no significant impact on death (HR 0.53 CI [0.22–1.28] p-value 0.16) or ICU admission (HR 0.8; CI [0.25–2.54] p-value 0.70) in the Cox regression model, nor on length of stay in linear regression (estimate 1.71; SE 2.37; p-value 0.47). After adjusting for age, we found no significant correlation between urinary antigen positivity and variations in the WHO ordinal scale and laboratory markers at admission and after 14 days. We found that a positive PUA result was not frequent and had no impact on clinical outcomes or clinical improvement. Our results did not support the routine use of PUA tests to select COVID-19 patients who will benefit from antibiotic therapy.

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Lack of Association Between 25-Hydroxyvitamin D Level and Outcomes in Hospitalized Indian Patients With COVID-19

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.563 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A277-A278

Author(s):

Ganesh Jevalikar ◽

Rutuja Sharma ◽

Khalid J Farooqui ◽

Anshu Singh ◽

Sandeep Budhiraja ◽

...

Keyword(s):

Clinical Outcomes ◽

Inflammatory Markers ◽

Severe Disease ◽

Laboratory Data ◽

Ordinal Scale ◽

Nasopharyngeal Swab ◽

Icu Admission ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

D Dimer

Abstract Vitamin D deficiency (VDD) is thought to play a role in determining the outcomes of COVID-19. India has a high prevalence of VDD. We hypothesized that VDD as measured by serum 25-hydroxyvitamin D (25OHD) <20 ng/mL is associated with severe COVID-19 infection. Outcomes were assessed by the WHO ordinal scale for clinical improvement (OSCI)1, the need for oxygen therapy, admission to an intensive care unit (ICU), and inflammatory markers. The diagnosis of COVID-19 was proven by RT-PCR on the nasopharyngeal swab for SARS-CoV2. Serum 25OHD and PTH were measured in addition to the standard protocol for COVID-19. Clinical and laboratory data were extracted from electronic medical records and analyzed using SPSS v22.0. Patients with OSCI score < 5 were classified as mild and ≥5 as severe disease. The study was approved by the Institutional Ethics Committee. A total of 410 patients (127 females, 9 pediatric, 17 asymptomatic) were included with a median age of 54 years (6–92 years) with 272(66.3%) having at least one co-morbid condition, including diabetes (190, 46.3%) and hypertension (164,40%). Patients with VDD (197,48%) were significantly younger (46.7±17.1 vs. 57.8±14.7 years) and had lesser prevalence of diabetes and hypertension (39.1% vs 52.4%, 29.4% vs 49.5%). Proportion of severe cases (26,13.2% vs. 31,14.6%), mortality (4, 2% vs. 11, 5.2%), oxygen requirement (68,34.5% vs.92,43.4), ICU admission (29, 14.7% vs. 42, 19.8%), need for inotropes (7,3.6% vs.12,5.7%) was not significantly different between patients with VDD and those with normal 25OHD level. The proportion of severe cases was similar across all 25OHD categories. There was no significant correlation between 25OHD levels and outcome OSCI, inflammatory markers (CRP, IL-6, D-dimer, ferritin, LDH). PTH levels positively correlated with D-dimer (r 0.117, p- 0.019), ferritin (r 0.132, p-0.010) and LDH (r0.124, p-0.018). Amongst VDD patients, 128(64.9%) were treated with cholecalciferol with a median dose of 60000 IU. The proportion of severe cases, oxygen, or ICU admission was not significantly different in the treated vs. untreated group. In conclusion, baseline levels of 25OHD did not determine the severe clinical outcomes of COVID-19 or levels of inflammatory markers. Treatment with cholecalciferol did not make any difference to the clinical outcomes of those with VDD. Reference:1WHO R&D Blueprint, novel Coronavirus. Retrieved from: https://www.who.int/blueprint/priority-diseases/key-action/COVID-19_Treatment_Trial_Design_Master_Protocol_synopsis_Final_18022020.pdf

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Measurement of Dead Space Fraction Upon ICU Admission Predicts Length of Stay and Clinical Outcomes Following Bidirectional Cavopulmonary Anastomosis*

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000001378 ◽

2018 ◽

Vol 19 (1) ◽

pp. 23-31 ◽

Cited By ~ 6

Author(s):

Claire L. Cigarroa ◽

Sarah J. van den Bosch ◽

Xiaoqi Tang ◽

Kimberlee Gauvreau ◽

Christopher W. Baird ◽

...

Keyword(s):

Length Of Stay ◽

Clinical Outcomes ◽

Dead Space ◽

Icu Admission ◽

Cavopulmonary Anastomosis ◽

Bidirectional Cavopulmonary Anastomosis

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Clinical outcomes of colistin in combination with either 6-g sulbactam or carbapenems for the treatment of extensively drug-resistant Acinetobacter baumannii pneumonia with high MIC to sulbactam, a prospective cohort study

10.21203/rs.2.10942/v1 ◽

2019 ◽

Author(s):

Chutchawan Ungthammakhun ◽

Vasin Vasikasin ◽

Dhitiwat Changpradub

Keyword(s):

Cohort Study ◽

Length Of Stay ◽

Acinetobacter Baumannii ◽

Clinical Outcomes ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Mortality Rates ◽

P Value ◽

Drug Resistant ◽

Extensively Drug Resistant

Abstract Background: Extensively drug-resistant Acinetobacter baumannii (XDRAB) is an important cause of nosocomial pneumonia with limited therapeutic options. Colistin based regimen is recommended treatment. Which drugs should be combined with colistin remains uncertain. The aim of this study was to investigate the clinical outcomes of patients with XDRAB pneumonia who were treated with colistin, combined with either 6-g sulbactam or carbapenems, in the setting of high MIC to sulbactam. Methods: In this prospective cohort study, hospitalized patients diagnosed with XDRAB pneumonia in Phramongkutklao Hospital were enrolled. The primary outcome was the 28-day mortality. Secondary outcomes were 7 and 14-day mortality, length of stay, ventilator days and factors associated with mortality. Results: From 1 July 2016 to 30 September 2017, 192 patients were included; 92 received colistin plus sulbactam and 90 received colistin plus carbapenems. Most of the patients were male diagnosed with ventilator associated pneumonia in medical intensive care unit. Overall mortality rates at 7, 14, 28 days were 24.2%, 37.4%, 53.3%, respectively. Mortality rates did not differ between sulbactam group and carbapenems groups at 7 days (19.6% vs. 28.9%, p-value 0.424, adjusted HR 1.277; 95% CI = 0.702-2.322), 14 days (34.8% vs. 40%, p = 0.658, adjusted HR 1.109; 95% CI = 0.703-1.749) and 28 days (51.1% vs. 55.6%, p = 0.857, adjusted HR 1.038; 95% CI = 0.690-1.562). Length of stay, ICU days and ventilator days did not differ. Complications of treatment including acute kidney injury were not statistically different. Conclusions: In XDRAB pneumonia with high MIC to sulbactam, mortality rates were not statistically significant between colistin plus 6-g sulbactam and colistin plus carbapenems. Keywords: XDR A. baumannii pneumonia, mortality rate, colistin based, sulbactam, carbapenems

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Current Prevalence of Specific Clinical Outcomes in Adult Patients with Hb SS or Hb Sβ0 Thalassemia.

Blood ◽

10.1182/blood.v108.11.1201.1201 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1201-1201

Author(s):

Laura M. De Castro ◽

Felicia C. Lennon-Graham ◽

Allison G. Ashley-Koch ◽

Jude C. Jonassaint ◽

James J. Eckman ◽

...

Keyword(s):

Clinical Outcomes ◽

Sickle Cell ◽

Laboratory Data ◽

Adult Patients ◽

Prescribing Patterns ◽

Acute Chest Syndrome ◽

P Value ◽

Transfusion Therapy ◽

The Past ◽

Long Acting

Abstract Over the last five years, we have enrolled 541 unrelated adult patients (age >18) with HbSS or HbSβ0 at three major comprehensive sickle cell centers in a study designed to identify factors associated with clinical outcomes in sickle cell disease. Our database includes demographic, clinical, and laboratory data on all participants. Medical history was obtained by both patient interview and review of medical records. The average age of patients enrolled was 34.0 yrs, median age 31.9, and 61 were ≥ 50 yrs; 54% were female. 81% of patients had finished high school, and 35% smoked tobacco products. History of SCD-related complications was as follows: acute chest syndrome - 76%, priapism (males only) - 41%, stroke - 16%, TIA - 5%, seizure - 12%, AVN of shoulders or hips - 30%, leg ulcers - 26%, heart failure - 7%, gallstones - 66%, and retinopathy - 22%. 68% of patients had undergone cholecystectomy, 11% splenectomy, and 11% major joint replacement. 136 patients had echocardiography data reported, and of these 39% had findings consistent with pulmonary hypertension, as defined as TRjet ≥ 2.5 m/s. 7% were receiving chronic transfusion therapy, and 6% were receiving iron chelation therapy. Significant proteinuria (≥ 1+) was present in 27% of patients, while only 4% had hematuria. Review of medication usage revealed that 40% were taking hydroxyurea (HU) at the time of enrollment, and 23% used long-acting narcotics daily. 14% of patients took medication for hypertension, 9% took antidepressants, and 6% used bronchodilators. Interviews and review of records showed that 21% had not required hospitalization during the past year, while 25% were hospitalized only once, 46% were hospitalized 2–4 times, and 8% were hospitalized >4 times during the past year. Hematologic values and HU status were available for 433 patients. Hematologic Values On HU Not On HU Mean Std Dev N Mean Std Dev N p value Hb 8.9 1.62 174 8.29 1.46 259 <0.001 Hct 25.85 4.62 174 24.25 4.39 259 0.0003 WBC 10.52 4.06 173 12.31 5.04 259 0.0001 Platelets 409.03 142.03 173 405.61 144.21 258 0.75 Patients not on HU had significantly higher total bilirubin values (3.51±2.66 vs 2.91±2.93, p=0.02) and insignificantly higher ferritin levels (1297±2118 vs 1089±1535, p=0.5). However, patients taking HU had higher LDH (p=0.0019) and uric acid levels (p<0.0001). In summary, despite frequent use of HU, resulting in statistically higher hemoglobin levels and lower WBC, the prevalence of end-organ complications associated with SCD remains high. More than half of all patients were hospitalized at least twice annually, and almost one-quarter required daily long-acting narcotics. 30% of patients have AVN, and more than 10% of patients had already undergone major joint surgery. Further research into HU prescribing patterns and patient compliance might lead to improvement in patient outcomes, but other interventions are likely to be required in order to ameliorate the persistently high complication rate of SCD.

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Abstract 16173: Clinical Characteristics and Short-term Outcomes of Hospitalized Patients With Sars-cov-2 Infection and Reduced Left Ventricular Ejection Fraction

Circulation ◽

10.1161/circ.142.suppl_3.16173 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Gatha G Nair ◽

Joanne Michelle M Gomez ◽

Setri S Fugar ◽

Jeanne du Fay de Lavallaz ◽

Max Ruge ◽

...

Keyword(s):

Length Of Stay ◽

Ejection Fraction ◽

Clinical Outcomes ◽

Left Ventricular ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Left Ventricular Ejection ◽

Short Term ◽

Ventricular Ejection Fraction ◽

Icu Admission

Introduction: Early studies of coronavirus disease 2019 (COVID-19) patients suggested that heart failure (HF) may lead to poorer prognosis. We evaluated demographics and short-term clinical outcomes of patients with evidence of left ventricular systolic dysfunction (LVSD) in comparison to those with preserved LV systolic function (PSF). Methods: In this retrospective study of patients hospitalized for COVID-19 between March and June 2, 2020 at Rush Health Systems in Metro Chicago, demographics, comorbidities and clinical outcomes of patients who demonstrated LVSD (ejection fraction [EF] <50%) on transthoracic echocardiogram (TTE) were compared to that of controls with PSF. Results: Out of 1,312 hospitalized patients, 225 underwent TTE, and 44 patients showed LVSD. Demographics were similar between two groups, with exception of a higher prevalence of African American (AA) race (48 % vs. 29%; p=0.03) in the LVSD group. While 82% of patients in the LVSD cohort had history of chronic HF, only 26% of patients in the PSF had pre-existing HF (p<0.001). Underlying comorbidities were similar between groups: obesity (39% vs. 36%; p=0.86), diabetes (57% vs. 57%; p=1.0), hypertension (70% vs. 66%; p=0.72) and end-stage renal disease (20% vs. 19%; p=0.83). Coronary artery disease trended toward a higher frequency (50% vs. 34%; p=0.058) in the LVSD group. Troponin elevation (18% vs. 12%; p=0.43), vasopressor use (57% vs. 56%; p=1.0), endotracheal intubation (59% vs. 57%; p=0.87), myocardial infarction (30% vs. 23%; p=0.43), ICU admission (75% vs. 75%; p=1.0), hospital length of stay (median 11 days vs. 15 days; p=0.4), and death (25% vs. 23%; p=0.84) were similar between groups. Patients with LVSD had higher incidence of sustained ventricular tachycardia or fibrillation than those with PSF (18% vs. 6%; p=0.016). Conclusions: In our COVID-19 admissions, LVSD was more common in AA patients. Patients with LVSD had a higher risk of ventricular arrhythmias. However, there were no differences between need for ICU admission or intubation, vasopressor requirements, length of stay or death between patients with LVSD and those without. Longitudinal follow-up studies are needed to identify differences in long-term sequelae of COVID-19 infection with evidence for LVSD.

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ICU Outcomes and Survival in Patients with Severe COVID-19 in the Largest Health Care System in Central Florida

10.1101/2020.08.25.20181909 ◽

2020 ◽

Author(s):

Eduardo Oliveira ◽

Amay Parikh ◽

Arnaldo Lopez-Ruiz ◽

Maria Carrillo ◽

Joshua Goldberg ◽

...

Keyword(s):

Health Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Health Care System ◽

Severity Of Illness ◽

Icu Patients ◽

Icu Admission ◽

Related Mortality ◽

Care System

Background Observational studies have consistently described poor clinical outcomes and increased ICU mortality in patients with severe coronavirus disease 2019 (COVID-19) who require mechanical ventilation (MV). Our study describes the clinical characteristics and outcomes of patients with severe COVID-19 admitted to ICU in the largest health care system in the state of Florida, United States. Methods Retrospective cohort study of patients admitted to ICU due to severe COVID-19 in AdventHealth health system in Orlando, Florida from March 11th until May 18th, 2020. Patients were characterized based on demographics, baseline comorbidities, severity of illness, medical management including experimental therapies, laboratory markers and ventilator parameters. Major clinical outcomes analyzed at the end of the study period were: hospital and ICU length of stay, MV-related mortality and overall hospital mortality of ICU patients. Results Out of total of 1283 patients with COVID-19, 131 (10.2%) met criteria for ICU admission (median age: 61 years [interquartile range {IQR}, 49.5-71.5]; 35.1% female). Common comorbidities were hypertension (84; 64.1%), and diabetes (54; 41.2%). Of the 131 ICU patients, 109 (83.2%) required MV and 9 (6.9%) received ECMO. Lower positive end expiratory pressure (PEEP) were observed in survivors [9.2 (7.7-10.4)] vs non-survivors [10 (9.1-12.9] p= 0.004]. Compared to non-survivors, survivors had a longer MV length of stay (LOS) [14 (IQR 8-22) vs 8.5 (IQR 5-10.8) p< 0.001], Hospital LOS [21 (IQR 13-31) vs 10 (7-1) p< 0.001] and ICU LOS [14 (IQR 7-24) vs 9.5 (IQR 6-11), p < 0.001]. The overall hospital mortality and MV-related mortality were 19.8% and 23.8% respectively. After exclusion of hospitalized patients, the hospital and MV-related mortality rates were 21.6% and 26.5% respectively. Conclusions Our study demonstrates an important improvement in mortality of patients with severe COVID-19 who required ICU admission and MV in comparison to previous observational reports and emphasize the importance of standard of care measures in the management of COVID-19.

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Designing and Evaluating the Establishment of Admission Criteria for Patients in an Intensive Care Unit: A Descriptive Study in Iran

Evidence Based Health Policy Management and Economics ◽

10.18502/jebhpme.v5i2.6554 ◽

2021 ◽

Author(s):

Fariba Hosseinpour ◽

Mahyar Sedighi ◽

Fariba Hashemi ◽

Sima Rafiei

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Statistical Tests ◽

P Value ◽

Admission Criteria ◽

Total Cost ◽

Icu Admission ◽

Study Results ◽

Significant Difference

Background: A few studies have reviewed and revised ICU admission criteria based on specific circumstances and local conditions. The aim was to develop ICU admission criteria and compare the cost, mortality, and length of stay among identified admission priorities. Methods: This was a cross-sectional study conducted in an intensive care unit of a training hospital in Qazvin, Iran. The study was conducted among 127 patients admitted to ICU from July to September 2019. The data collection tool was a self-designed checklist, which included items regarding patients' clinical data and their billing, type of diagnosis, level of consciousness at the time of hospitalization based on GCS scale or Glasgow Coma Scale, length of stay, and patient status at the time of discharge. Descriptive statistical tests were used to describe study variables, and in order to determine the relationship between study variables, ANOVA and Chi-square test were used. Results: A set of criteria were designed to prioritize patient admissions in ICU. Based on the defined criteria, patients were categorized into four groups based on patient's stability, hemodynamic, and respiration. Study findings revealed that a significant percentage of patients were admitted to the ward while in the second and third priorities of hospitalization (26.8 % and 32.3 %, respectively). There was a statistically significant difference in the four groups in terms of patients' age, total cost, and insurance share of the total cost (P-value < 0.05). Conclusion: Study results emphasize the necessity to classify patients based on defined criteria to efficiently use available resources.

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Investigation of subsequent and co-infections associated with SARS-CoV-2 (COVID-19) in hospitalized patients

10.1101/2020.05.29.20117176 ◽

2020 ◽

Cited By ~ 3

Author(s):

Matthew P. Crotty ◽

Ronda Akins ◽

An Nguyen ◽

Rania Slika ◽

Kristen Rahmanzadeh ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Cox Regression ◽

Hospitalized Patients ◽

Corticosteroid Administration ◽

Cox Regression Analysis ◽

Icu Admission ◽

Cell Counts ◽

Increased Risk

AbstractBackgroundSARS-CoV-2 has drastically affected healthcare globally and causes COVID-19, a disease that is associated with substantial morbidity and mortality. We aim to describe rates and pathogens involved in co-infection or subsequent infections and their impact on clinical outcomes among hospitalized patients with COVID-19.MethodsIncidence of and pathogens associated with co-infections, or subsequent infections, were analyzed in a multicenter observational cohort. Clinical outcomes were compared between patients with a bacterial respiratory co-infection (BRC) and those without. A multivariable Cox regression analysis was performed evaluating survival.ResultsA total of 289 patients were included, 48 (16.6%) had any co-infection and 25 (8.7%) had a BRC. No significant differences in comorbidities were observed between patients with co-infection and those without. Compared to those without, patients with a BRC had significantly higher white blood cell counts, lactate dehydrogenase, C-reactive protein, procalcitonin and interleukin-6 levels. ICU admission (84.0 vs 31.8%), mechanical ventilation (72.0 vs 23.9%) and in-hospital mortality (45.0 vs 9.8%) were more common in patients with BRC compared to those without a co-infection. In Cox proportional hazards regression, following adjustment for age, ICU admission, mechanical ventilation, corticosteroid administration, and pre-existing comorbidities, patients with BRC had an increased risk for in-hospital mortality (adjusted HR, 3.37; 95% CI, 1.39 to 8.16; P = 0.007). Subsequent infections were uncommon, with 21 infections occurring in 16 (5.5%) patients.ConclusionsCo-infections are uncommon among hospitalized patients with COVID-19, however, when BRC occurs it is associated with worse clinical outcomes including higher mortality.

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POS0047 OUTCOMES IN INFLAMMATORY ARTHROPATHY PATIENTS HOSPITALIZED FOR COVID-19

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.482 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 228.2-229

Author(s):

T. Collins ◽

V. Patel ◽

A. Babajanians ◽

S. Kubomoto

Keyword(s):

Rheumatoid Arthritis ◽

Length Of Stay ◽

Odds Ratio ◽

Inflammatory Markers ◽

Composite Endpoint ◽

P Value ◽

Invasive Ventilation ◽

Icu Admission ◽

Inflammatory Arthropathy ◽

Comorbidity Index

Background:Covid 19 is a new and rapidly spreading corona virus which has reached pandemic proportions. As of 5/22/20 there are 5.08 million confirmed cases and 332,000 deaths worldwide. Primary manifestations are respiratory, with a subset developing severe hypoxic respiratory failure. Several risk factors predispose patients to worse outcomes including age, obesity, hypertension, chronic kidney disease, COPD, asthma, CHF, and diabetes. This is a retrospective cohort analysis of patients with Rheumatoid arthritis, Ankylosing spondylitis, or Psoriatic arthritis who were hospitalized for COVID-19 infection across 165 HCA hospitals from 1/1/2020 to 5/30/2020. We compared endpoints and calculated odds of ICU admission, invasive ventilation, mortality compared to control as well as length of stay and discharge location.Objectives:Our objectives include measuring the outcome of Patients in two arms, the first being those with Rheumatoid arthritis, Ankylosing spondylitis, and Psoriatic arthritis who are infected with COVID 19 to an age matched and comorbidity matched arm (using the Charlson comorbidity index) for the composite endpoint of ICU admission, invasive ventilation, and death. We believe the inflammatory arthropathy arm will have a worse composite endpoint then the control arm. we will also attempt to calculate a hazard ratio of this arm vs the control to the composite endpoint. We will also examine the length of stay as well as inflammatory markers mentioned in between the two arms. We suspect initial inflammatory markers will be lower in the inflammatory arthropathy arm, particularly CRP and LDH, due to chronic immune modulating medication and these markers will not correlate as closely with severe illness represented by the composite endpoint as in the control arm.Methods:We analyzed 86,217 patients admitted with COVID-19 comparing 751 patients who had inflammatory arthropathy to patients who did not. T tests were used for parametric outcome and chi square tests for non-parametric outcomes. Multivariate analysis included potential confounders such as age, and comorbidities such as diabetes, heart disease, etc.Results:The odds ratio for mortality in the arthropathy arm was 1.37 with a confidence interval of 1.09 to 1.71 with a p value of 0.006. The odds ratio for ventilation was 1.35 with CI of 1.09 to 1.67 and p value of 0.006. The odds ratio of ICU admission was 1.46 with CI of 1.24 to 1.72 and P value of 0.000. The average length of stay of the arthropathy arm was 8.51 days +/- 10.02 vs 4.59 days +/- 8.26 of the control, p < 0.001. The discharge disposition of the arthropathy arm vs control group is as follows, 13.32% died inpatient vs 5.87% in the control, 56.72% were discharged home vs 77.19%, 6.79% went to hospice care vs 3.10%, 4.79% remained inpatient at the end of the study interval vs 3.45%, 17.18% were discharged to rehab vs 8.43%, and other discharges not included in the above groupings were 1.2% vs 1.96%, p<0.001. 31.29% of the arthropathy group required ICU admission vs 16.32% and 13.98% required ventilation vs 6.9%, p <0.001. The average age was higher in the arthropathy arm vs control at 66.56 years old vs 51.53, p <0.001. Charlson comorbidity index was also higher in the arthropathy arm at 2.72 vs 0.96, p <0.001.Conclusion:This is a large analysis of inflammatory arthropathy patients hospitalized with COVID-19. While the arthropathy group was older, and had more co-morbidities, when adjusting for potential confounders, inflammatory arthropathy patients had a higher risk of death and mechanical ventilation, as well as longer length of stay.Disclosure of Interests:None declared.

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Association of remdesivir with poor clinical outcomes in Covid-19

10.21203/rs.3.rs-894056/v1 ◽

2021 ◽

Author(s):

Rajat Ranka ◽

Arjun ◽

Prasan Kumar Panda ◽

Yogesh Arvind Bahurupi ◽

Gaurav Chikara ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clinical Trials ◽

Clinical Outcomes ◽

Cox Regression ◽

Statistical Significance ◽

Real Life ◽

North India ◽

P Value ◽

Clinical Recovery ◽

The World

Abstract Introduction: Need of an antiviral against Covid-19 prompted clinical trials all over the world and based on initial promising trends, remdesivir was widely used all over the world, including India (compassionate use). Subsequent trials have been conflicting in their results and the utility of the drug has been widely debated. Methods: This is a record-based retrospective cohort study carried out in a 1000-bedded government teaching hospital in North India. The medical e-records of the Covid-19 positive patients who were admitted between June and November 2020 were reviewed for eligibility. After making the necessary exclusions, 112 patients were included in the remdesivir cohort and 85 in the standard care cohort. All the baseline characteristics of relevance and details of hospital admission were collected. The following outcomes in relation to remdesivir administration were assessed: all-cause mortality until discharge – stratified as per baseline oxygen support, age, gender and comorbidities; proportion of severe and non-severe patients progressing to mechanical ventilation later on; and time to clinical recovery in survivors. Results: There was a statistically significant association of higher mortality with the administration of remdesivir (odds ratio, OR 2.3, p-value 0.008) with a Cox regression hazard ratio of 1.590 (CI 0.944–2.679). The trend towards poorer outcomes in the remdesivir cohort persisted even after sub-stratification for age, gender, baseline severity (oxygen need) and comorbidities but failed to reach statistical significance in most of the strata. Similarly, remdesivir administration was associated with higher rates of progression to mechanical ventilation amongst those severe and non-severe patients who were not on mechanical ventilation at admission (49 % versus 15 %, p-value < 0.001, OR 5.2). This association was significant overall as well as for severe category patients when assessed separately (56% versus 26 %, p-value 0.04, OR 3.1). There was, however, no difference in the days taken for clinical recovery between the two groups (13.23 days versus 12.8 days, p-value 0.77). Conclusion: Remdesivir administration was associated with overall worse clinical outcomes. This study contradicts the benefits shown with remdesivir in previous clinical trials done in controlled settings and highlights the challenges that newer therapies face in real life hospital settings. There is a need to include diverse ethnic groups in the future clinical trials of the drug if to be used.

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