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All Studies   Meta Analysis    Recent:   

The Prognostic Value of Eosinophil Recovery in COVID-19: A Multicentre, Retrospective Cohort Study on Patients Hospitalised in Spanish Hospitals

Gonzalez et al., medRxiv, doi:10.1101/2020.08.18.20172874
Aug 2020  
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Mortality 27% Improvement Relative Risk HCQ for COVID-19  Gonzalez et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 9,644 patients in Spain Lower mortality with HCQ (not stat. sig., p=0.057) c19hcq.org Gonzalez et al., medRxiv, August 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 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
Retrospective study focused on eosinophil recovery with 9,644 hospitalized patients in Spain, showing lower mortality for HCQ (14.7% vs 29.2%, p<0.001), and AZ (15.3% vs. 18.4%, p<0.001). With a multivariate model including potential confounding factors, HCQ and AZ are associated with lower mortality, HCQ OR 0.662, p=0.057.
Although the 27% lower mortality is not statistically significant, it is consistent with the significant 26% lower mortality [22‑30%] from meta analysis of the 249 mortality results to date.
risk of death, 26.6% lower, RR 0.73, p = 0.06, treatment 1,246 of 8,476 (14.7%), control 341 of 1,168 (29.2%), NNT 6.9, adjusted per study, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Gonzalez et al., 21 Aug 2020, retrospective, database analysis, Spain, preprint, 25 authors.
This PaperHCQAll
The Prognostic Value of Eosinophil Recovery in COVID-19: A Multicentre, Retrospective Cohort Study on Patients Hospitalised in Spanish Hospitals
María Mateos González, Elena Sierra Gonzalo, Irene Casado Lopez, Francisco Arnalich Fernández, José Luis Beato Pérez, Daniel Monge Monge, Juan Antonio Vargas Núñez, Rosa García Fenoll, Carmen Suárez Fernández, Santiago Jesús Freire Castro, Manuel Mendez Bailon, Isabel Perales Fraile, MD PhD l Manuel Madrazo, Paula Maria Pesqueira Fontan, Jeffrey Oskar Magallanes Gamboa, Andrés González García, Anxela Crestelo Vieitez, Eva María Fonseca Aizpuru, Asier Aranguren Arostegui, Ainara Coduras Erdozain, Carmen Martinez Cilleros, Jose Loureiro Amigo, MD PhD Francisco Epelde, Carlos Lumbreras Bermejo, Juan Miguel Antón Santos
doi:10.1101/2020.08.18.20172874
Objectives: A decrease in blood cell counts, especially lymphocytes and eosinophils, has been described in patients with severe SARS-CoV-2 (COVID-19), but there is no knowledge of the potential role of their recovery in these patients' prognosis. This article aims to analyse the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. Design: This work is a multicentre, retrospective, cohort study of 9,644 hospitalised patients with confirmed COVID-19 from the Spanish Society of Internal Medicine's SEMI-COVID-19 Registry. Setting: This study examined patients hospitalised in 147 hospitals throughout Spain. Participants: This work analysed 9,644 patients (57.12% male) out of a cohort of 12,826 patients ≥18 years of age hospitalised with COVID-19 in Spain included in the SEMI-COVID-19 Registry as of 29 May 2020. Main outcome measures: The main outcome measure of this work is the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. Univariate analysis was performed to determine possible predictors of death and then multivariate analysis was carried out to control for potential confounders. Results: An increase in the eosinophil count on the seventh day of hospitalisation was associated with a better prognosis, including lower mortality rates (5.2% vs 22.6% in non-recoverers, OR 0.234 [95% CI, 0.154 to 0.354]) and lower complication rates, especially regarding to development of acute respiratory distress syndrome (8% vs 20.1%, p=0.000) and ICU admission (5.4% vs 10.8%, p=0.000). Lymphocyte recovery was found to have no effect on prognosis. Treatment with inhaled or systemic glucocorticoids was not found to be a confounding factor. Conclusion: Eosinophil recovery in patients with COVID-19 is a reliable marker of a good prognosis that is independent of prior treatment. This finding could be used to guide discharge decisions.
CONFLICTS OF INTEREST The authors declare that there are no conflicts of interest.
References
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Asosingh, Aronica, Eosinophils: Ancient cells with new roles in chronic lung inflammation, American Journal of Respiratory and Critical Care Medicine
Casas-Rojo, M Antón-Santos, Millán-Núñez-Cortés, Lumbreras-Bermejo, Ramos-Rincón et al., Clinical characteristics of patients hospitalized with COVID-19 in Spain: results from the SEMI-COVID-19 Registry, Revista Clínica Española, doi:10.1016/j.rce.2020.07.003
Chen, Wu, Chen, Yang, Chen, Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study, BMJ
Ciotti, Angeletti, Minieri, Giovannetti, Benvenuto et al., COVID-19 Outbreak: An Overview, Chemotherapy
Cucinotta, Vanelli, WHO declares COVID-19 a pandemic, Acta Biomed
De Ruiter, Tahapary, Sartono, Soewondo, Supali et al., Helminths, hygiene hypothesis and type 2 diabetes
Esser, Legrand-Poels, Piette, Scheen, Paquot, Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes
Frater, Zini, Onofrio, Rogers, COVID-19 and the clinical hematology laboratory
Halpin, Faner, Sibila, Badia, Agusti, Do chronic respiratory diseases or their treatment affect the risk of SARS-CoV-2 infection?, Lancet Respir Med
Huang, Wang, Li, Ren, Zhao et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet
Lindsley, Schwartz, Rothenberg, Eosinophil responses during COVID-19 infections and coronavirus vaccination, Journal of Allergy and Clinical Immunology
Lippi, Henry, Eosinophil count in severe coronavirus disease, doi:10.1093/qjmed/hcaa137/5823309
Liu, Xu, Zhang, Yan, Pan, Patients of COVID-19 may benefit from sustained lopinavir-combined regimen and the increase of eosinophil may predict the outcome of COVID-19 progression, Int J Infect Dis
Lu, Stratton, Tang, Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle, J Med Virol
Qin, Zhou, Hu, Zhang, Yang et al., Dysregulation of immune response in patients with COVID-19
Ravin, Loy, Liu, Zhi, Ying, COVID-19 and Asthma: Reflection During the Pandemic, Clinical Reviews in Allergy and Immunology
Sun, Cai, Wang, He, Lin et al., Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China, Clin Chim Acta
Wu, Mcgoogan, Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention, JAMA -J Am Med Assoc
Zhang, Wang, Jia, Li, Hu et al., Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China, Clin Microbiol Infect
Zheng, Peng, Xu, Zhao, Liu et al., Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis, Journal of Infection
Zhou, Yu, Du, Fan, Liu et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet
Zhu, Zhang, Li, Yang, Song, A novel coronavirus from patients with pneumonia in China, 2019, N Engl J Med
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This article aims to analyse the effect of ' 'blood cell depletion and blood cell recovery on mortality due to ' 'COVID-19.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>This work is a ' 'multicentre, retrospective, cohort study of 9,644 hospitalised patients with confirmed ' 'COVID-19 from the Spanish Society of Internal Medicine’s SEMI-COVID-19 ' 'Registry.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>This study ' 'examined patients hospitalised in 147 hospitals throughout ' 'Spain.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>This work ' 'analysed 9,644 patients (57.12% male) out of a cohort of 12,826 patients ≥18 years of age ' 'hospitalised with COVID-19 in Spain included in the SEMI-COVID-19 Registry as of 29 May ' '2020.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>The ' 'main outcome measure of this work is the effect of blood cell depletion and blood cell ' 'recovery on mortality due to COVID-19. Univariate analysis was performed to determine ' 'possible predictors of death and then multivariate analysis was carried out to control for ' 'potential ' 'confounders.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>An increase ' 'in the eosinophil count on the seventh day of hospitalisation was associated with a better ' 'prognosis, including lower mortality rates (5.2% vs 22.6% in non-recoverers, OR 0.234 [95% ' 'CI, 0.154 to 0.354]) and lower complication rates, especially regarding to development of ' 'acute respiratory distress syndrome (8% vs 20.1%, p=0.000) and ICU admission (5.4% vs 10.8%, ' 'p=0.000). Lymphocyte recovery was found to have no effect on prognosis. 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Late treatment
is less effective
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