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Clinical Profile of First 1000 COVID-19 Cases Admitted at Tertiary Care Hospitals and the Correlates of their Mortality: An Indian Experience

Budhiraja et al., medRxiv, doi:10.1101/2020.11.16.20232223
Nov 2020  
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Mortality 65% Improvement Relative Risk HCQ for COVID-19  Budhiraja et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 976 patients in India Lower mortality with HCQ (p<0.000001) c19hcq.org Budhiraja et al., medRxiv, November 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 418 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments.
5,000+ studies for 104 treatments. c19hcq.org
Retrospective 976 hospitalized patients with 834 treated with HCQ+AZ showing HCQ mortality relative risk RR 0.35, p < 0.0001. Note that in this case HCQ was recommended for mild/moderate cases, so more severe cases may not have received HCQ (which may also be why they became severe cases). We note that this is opposite to a common bias in HCQ studies - in many cases HCQ was more likely to be given to more severe cases.
This study is excluded in the after exclusion results of meta analysis: excessive unadjusted differences between groups.
Study covers ivermectin and HCQ.
risk of death, 65.4% lower, RR 0.35, p < 0.001, treatment 69 of 834 (8.3%), control 34 of 142 (23.9%), NNT 6.4.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Budhiraja et al., 18 Nov 2020, retrospective, India, preprint, 12 authors.
This PaperHCQAll
Clinical Profile of First 1000 COVID-19 Cases Admitted at Tertiary Care Hospitals and the Correlates of their Mortality: An Indian Experience
Sandeep Budhiraja, Aakriti Soni, Vinitaa Jha, Dr Abhaya Indrayan, Arun Dewan, Omender Singh, Yogendra Pal Singh, Indermohan Chugh, Vijay Arora, Rajesh Pande, Abdul Ansari, Sujeet Jha
doi:10.1101/2020.11.16.20232223
Objective: To describe the clinical profile and factors leading to increased mortality in coronavirus disease (COVID-19) patients admitted to a group of hospitals in India. Design: A records-based study of the first 1000 patients with a positive result on real-time reverse transcriptase-polymerase-chain-reaction assay for SARS-CoV-2 admitted to our facilities. Various factors such as demographics, presenting symptoms, co-morbidities, ICU admission, oxygen requirement and ventilator therapy were studied. Results: Of the 1000 patients, 24 patients were excluded due to lack of sufficient data. Of the remaining 976 in the early phase of the epidemic, males were admitted twice as much as females (67.1% and 32.9%, respectively). Mortality in this initial phase was 10.6% and slightly higher for males and steeply higher for older patients. More than 8% reported no symptoms and the most common presenting symptoms were fever (78.3%), productive cough (37.2%), and dyspnea (30.64%). More than one-half (53.6%) had no co-morbidity. The major co-morbidities were hypertension (23.7%), diabetes without (15.4%), and with complications (9.6%). The co-morbidities were associated with higher ICU admissions, greater use of ventilators as well as higher mortality. A total of 29.9% were admitted to the ICU, with a mortality rate of 32.2%. Mortality was steeply higher in those requiring ventilator support (55.4%) versus those who never required ventilation (1.4%). The total duration of hospital stay was just a day longer in patients admitted to the ICU than those who remained in wards. Conclusion: Male patients above the age of 60 and with co-morbidities faced the highest rates of mortality. They should be admitted to the hospital in early stage of the disease and given aggressive treatment to help reduce the morbidity and mortality associated with COVID-19.
Conflict of Interest: The authors report no conflict of interest. Ethical Approval: This study was approved by the ethics committee of MaxHealthcare (RS/MSSH/DDF/SKT-2/IEC/IM/20-16) Author contributions: Study conception and design: SB,AS. Acquisition, analysis, or interpretation of data: AI, VJ, AD, OS, YPS, IC, VA,RP,AA, AS. Drafting of the manuscript: AS. Critical revision of the manuscript for important intellectual content: SB, AI, VJ, SJ. Statistical analysis and interpretation: AI. Administrative, technical, or material support: VJ, AD, OS, YPS, IC, VA, RP, AA. Study supervision: SB, SJ, VJ. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare no support from any organization for the submitted work and no competing interests with regards to the submitted work.
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Late treatment
is less effective
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