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Clinical characteristics of hospitalised patients with COVID-19 and the impact on mortality: a single-network, retrospective cohort study from Pennsylvania state

Gadhiya et al., BMJ Open, doi:10.1136/bmjopen-2020-042549

Apr 2021

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HCQ for COVID-19

1st treatment shown to reduce risk in March 2020

^*, now known with p < 0.00000000001 from 422 studies, recognized in 42 countries.

Lower risk for mortality, hospitalization, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine complementary and synergistic treatments. ^* >10% efficacy in meta analysis with ≥3 clinical studies.

4,100+ studies for 60+ treatments. c19hcq.org

Retrospective 283 patients in the USA showing higher mortality with all treatments (not statistically significant). Confounding by indication is likely. In the supplementary appendix, authors note that the treatments were usually given for patients that required oxygen therapy. Oxygen therapy and ICU admission (possibly, the paper includes ICU admission for model 2 in some places but not others) were the only variables indicating severity used in adjustments. Time based confounding is likely because HCQ became increasingly controversial and less used over the time covered (March 1 to May 31, 2020), while overall treatment protocols during this period improved dramatically, i.e., more control patients likely come later in the period when treatment protocols were greatly improved.

This study is excluded in the after exclusion results of meta analysis: substantial confounding by time likely due to declining usage over the early stages of the pandemic when overall treatment protocols improved dramatically; substantial unadjusted confounding by indication likely.

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Study covers vitamin C, zinc, and HCQ.

risk of death, 4.8% higher, RR 1.05, p = 0.89, treatment 22 of 55 (40.0%), control 33 of 216 (15.3%), adjusted per study, odds ratio converted to relative risk, multivariate logistic regression.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Gadhiya et al., 8 Apr 2021, retrospective, USA, peer-reviewed, 4 authors, dosage not specified.

This Paper HCQ All

Clinical characteristics of hospitalised patients with COVID-19 and the impact on mortality: a single-network, retrospective cohort study from Pennsylvania state

Kinjal P Gadhiya, Dr Panupong Hansrivijit, Mounika Gangireddy, John D Goldman

BMJ Open, doi:10.1136/bmjopen-2020-042549

Objective COVID-19 is a respiratory disease caused by SARS-CoV-2 with the highest burden in the USA. Data on clinical characteristics of patients with COVID-19 in US population are limited. Thus, we aim to determine the clinical characteristics and risk factors for in-hospital mortality from COVID-19. Design Retrospective observational study. Setting Single-network hospitals in Pennsylvania state. Participants Patients with confirmed SARS-CoV-2 infection who were hospitalised from 1 March to 31 May 2020. Primary and secondary outcome measures Primary outcome was in-hospital mortality. Secondary outcomes were complications, such as acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS). Results Of 283 patients, 19.4% were non-survivors. The mean age of all patients was 64.1±15.9 years. 56.2% were male and 50.2% were white. Several factors were identified from our adjusted multivariate analyses to be associated with in-hospital mortality: increasing age (per 1-year increment; OR 1.07 (1.045 to 1.105)), hypoxia (oxygen saturation <95%; OR 4.630 (1.934 to 1.111)), opacity/infiltrate on imaging (OR 3.077 (1.276 to 7.407)), leucocytosis (white blood cell >10 109/µL ; OR 2.732 (1.412 to 5.263)), ferritin >336 ng/mL (OR 4.016 (1.195 to 13.514)), lactate dehydrogenase >200 U/L (OR 7.752 (1.639 to 37.037)), procalcitonin >0.25 ng/ mL (OR 2.404 (1.011 to 5.714)), troponin I >0.03 ng/ mL (OR 2.242 (1.080 to 4.673)), need for advanced oxygen support other than simple nasal cannula (OR 4.608-13.889 (2.053 to 31.250)), intensive care unit admission/transfer (OR 13.699 (6.135 to 30.303)), renal replacement therapy (OR 21.277 (5.025 to 90.909)), need for vasopressor (OR 22.222 (9.434 to 52.632)), ARDS (OR 23.810 (10.204 to 55.556)), respiratory acidosis (OR 7.042 (2.915 to 16.949)), and AKI (OR 3.571 (1.715 to 7.407)). When critically ill patients were analysed independently, increasing Sequential Organ Failure Assessment score (OR 1.544 (1.168 to 2.039)), AKI (OR 2.128 (1.111 to 6.667)) and ARDS (OR 6.410 (2.237 to 18.182)) were predictive of in-hospital mortality. Conclusion We reported the characteristics of ethnically diverse, hospitalised patients with COVID-19 from Pennsylvania state.

Competing interests None declared. Patient consent for publication Not required. Ethics approval The protocol of this study has been approved by the UPMC Pinnacle Institutional Review Board and UPMC Pinnacle Ethics Committee (#20E024). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available upon reasonable request. Raw data are available upon reasonable request. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is..

References

-Y, Hu, Clinical characteristics of coronavirus disease 2019 in China, New England Journal of Medicine

Alattar, Ibrahim, Shaar, Tocilizumab for the treatment of severe coronavirus disease 2019, J Med Virol

Annane, Pastores, Rochwerg, Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of critical care medicine (SCCM) and European Society of intensive care medicine (ESICM) 2017, Crit Care Med, doi:10.1097/CCM.0000000000002737

Annetta, Maviglia, Proietti, Use of corticosteroids in critically ill septic patients : a review of mechanisms of adrenal insufficiency in sepsis and treatment, Curr Drug Targets, doi:10.2174/138945009789108792

Arentz, Yim, Klaff, Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state, JAMA, doi:10.1001/jama.2020.4326

Beigel, Tomashek, Dodd, Remdesivir for the treatment of Covid-19 -final report, N Engl J Med, doi:10.1056/NEJMoa2007764

Bhimraj, Morgan, Shumaker, Infectious diseases Society of America guidelines on the treatment and management of patients with COVID-19, Clin Infect Dis

Biot, Daher, Chavain, Design and synthesis of hydroxyferroquine derivatives with antimalarial and antiviral activities, J Med Chem, doi:10.1021/jm0601856

Caly, Druce, Catton, The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro, Antiviral Res, doi:10.1016/j.antiviral.2020.104787

Campochiaro, Della-Torre, Cavalli, Efficacy and safety of tocilizumab in severe COVID-19 patients: a single-centre retrospective cohort study, Eur J Intern Med, doi:10.1016/j.ejim.2020.05.021

Cavalcanti, Zampieri, Rosa, Hydroxychloroquine with or without azithromycin in mild-to-moderate Covid-19, N Engl J Med Overseas Ed, doi:10.1056/NEJMoa2019014

Cheng, Luo, Wang, Kidney disease is associated with in-hospital death of patients with COVID-19, Kidney Int, doi:10.1016/j.kint.2020.03.005

Colafrancesco, Alessandri, Conti, COVID-19 gone bad: a new character in the spectrum of the hyperferritinemic syndrome?, Autoimmun Rev, doi:10.1016/j.autrev.2020.102573

Combes, Costa, Trouillet, Morbidity, mortality, and quality-of-life outcomes of patients requiring >or=14 days of mechanical ventilation, Crit Care Med, doi:10.1097/01.CCM.0000065188.87029.C3

Elseviers, Lins, Van Der Niepen, Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury, Crit Care, doi:10.1186/cc9355

Ferguson, Camporota, The Berlin definition of ARDS: an expanded rationale, Justification, and supplementary material, Intensive Care Med, doi:10.1007/s00134-012-2682-1

Ferreira, Bota, Bross, Serial evaluation of the SOFA score to predict outcome in critically ill patients, JAMA, doi:10.1001/jama.286.14.1754

Fowler, Truwit, Hite, Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized clinical trial, JAMA, doi:10.1001/jama.2019.11825

Gao, Tian, Yang, Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies, Biosci Trends, doi:10.5582/bst.2020.01047

Gautret, Lagier, Parola, Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an openlabel non-randomized clinical trial, Int J Antimicrob Agents, doi:10.1016/j.ijantimicag.2020.105949

Geleris, Sun, Platt, Observational study of hydroxychloroquine in hospitalized patients with Covid-19, N Engl J Med, doi:10.1056/NEJMoa2012410

Gustot, Multiple organ failure in sepsis: prognosis and role of systemic inflammatory, Curr Opin Crit Care, doi:10.1097/MCC.0b013e328344b446

Hazra, Using the confidence interval confidently, J Thorac Dis, doi:10.21037/jtd.2017.09.14

Jose, Manuel, COVID-19 cytokine storm: the interplay between inflammation and coagulation, Lancet Respir Med, doi:10.1016/S2213-2600(20)30216-2

José, Williams, Chambers, Proteinase-Activated receptors in fibroproliferative lung disease, Thorax, doi:10.1136/thoraxjnl-2013-204367

Joyner, Wright, Fairweather, Early safety indicators of COVID-19 convalescent plasma in 5,000 patients, medRxiv, doi:10.1101/2020.05.12.20099879

Khwaja, KDIGO clinical practice guidelines for acute kidney injury, Nephron Clin Pract, doi:10.1159/000339789

Kiabi, Alipour, Darvishi-Khezri, Zinc supplementation in adult mechanically ventilated trauma patients is associated with decreased occurrence of ventilator-associated pneumonia: a secondary analysis of a prospective, observational study, Indian J Crit Care Med, doi:10.4103/0972-5229.198324

Levey, Stevens, Schmid, A new equation to estimate glomerular filtration rate, Ann Intern Med, doi:10.7326/0003-4819-150-9-200905050-00006

Li, Han, Woodward, The impact of 2019 novel coronavirus on heart injury: a systematic review and meta-analysis

Li, Xu, Yu, Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan, J Allergy Clin Immunol

Luo, Liu, Qiu, Tocilizumab treatment in COVID-19: a single center experience, J Med Virol, doi:10.1002/jmv.25801

Martin, Viviand, Leone, Effect of norepinephrine on the outcome of septic shock, Crit Care Med, doi:10.1097/00003246-200008000-00012

Meduri, Kohler, Headley, Inflammatory cytokines in the BAL of patients with ARDS. persistent elevation over time predicts poor outcome, Chest, doi:10.1378/chest.108.5.1303

Morris, Cleary, Clarke, Secondary bacterial infections associated with influenza pandemics, Front Microbiol, doi:10.3389/fmicb.2017.01041

Myers, Parodi, Escobar, Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California, JAMA, doi:10.1001/jama.2020.7202

Rh, Liang, Yang, Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study, Eur Respir J

Richardson, Hirsch, Narasimhan, Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the new York City area, JAMA, doi:10.1001/jama.2020.6775

Ruocco, Cechinatti, Barbosa, Zinc and selenium status in critically ill patients according to severity stratification, Nutrition, doi:10.1016/j.nut.2017.07.009

Salazar, Perez, Ashraf, Treatment of coronavirus disease 2019 (COVID-19) patients with convalescent plasma, Am J Pathol

Scaroni, Armigliato, Cannavò, COVID-19 outbreak and steroids administration: are patients treated for Sars-Cov-2 at risk of adrenal insufficiency?, J Endocrinol Invest, doi:10.1007/s40618-020-01253-1

Tisoncik, Korth, Simmons, Into the eye of the cytokine storm, Microbiol Mol Biol Rev, doi:10.1128/MMBR.05015-11

Van Smeden, De Groot, Moons, No rationale for 1 variable per 10 events criterion for binary logistic regression analysis, BMC Med Res Methodol, doi:10.1186/s12874-016-0267-3

Velthuis, Van Den Worm, She, Sims, Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture, PLoS Pathog, doi:10.1371/journal.ppat.1001176

Vittinghoff, Mcculloch, Relaxing the rule of ten events per variable in logistic and COX regression, Am J Epidemiol, doi:10.1093/aje/kwk052

Vrsalovic, Presecki, Cardiac troponins predict mortality in patients with COVID-19: a meta-analysis of adjusted risk estimates, J Infect, doi:10.1016/j.jinf.2020.05.022

Wang, Calfee, Paul, One-Year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome, Intensive Care Med, doi:10.1007/s00134-013-3186-3

Zhang, Jativa, Vitamin C supplementation in the critically ill: a systematic review and meta-analysis, SAGE Open Med, doi:10.1177/2050312118807615

Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet, doi:10.1016/S0140-6736(20)30566-3

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