Predictors of Mortality and Effect of Drug Therapies in Mechanically Ventilated Patients With Coronavirus Disease 2019: A Multicenter Cohort Study

Lambermont et al., Critical Care Explorations, doi:10.1097/CCE.0000000000000305

Lambermont et al., Predictors of Mortality and Effect of Drug Therapies in Mechanically Ventilated Patients With Coronavirus.., Critical Care Explorations, doi:10.1097/CCE.0000000000000305

Nov 2020 Source PDF

Twitter
Facebook

All Studies Meta

Retrospective 247 mechanically ventilated patients showing lower mortality with HCQ, but not statistically significant on multiple Cox regression.

The paper gives the p value for multiple Cox (0.46) and simple Cox (0.02), but does not specify the adjusted risk values.

Although the 32% lower mortality is not statistically significant, it is consistent with the significant 24% lower mortality [19‑28%] from meta analysis of the 237 mortality results to date.

Important missing comments or errors? Let us know.

risk of death, 32.3% lower, RR 0.68, p = 0.46, treatment 97 of 225 (43.1%), control 14 of 22 (63.6%), NNT 4.9, adjusted per study.

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

Lambermont et al., 28 Nov 2020, retrospective, Belgium, peer-reviewed, 15 authors.

All Studies Meta Analysis Submit Updates or Corrections

This Paper HCQ All

Letter to the Editor

We conducted a multicenter cohort study to determine the effect of drug therapies on survival in mechanically ventilated patients with coronavirus disease 2019. All consecutive adult patients admitted to ICU for coronavirus disease 2019 from March 1, 2020, to April 25, 2020, and under invasive mechanical ventilation for more than 24 hours were included. Out of 2,003 patients hospitalized for coronavirus disease 2019, 361 were admitted to ICU, 257 were ventilated for more than 24 hours, and 247 were included in the study. Simple and multiple time-dependent Cox regression models were used to assess the effects of factors on survival. Methylprednisolone administration during the first week of mechanical ventilation was associated with a decrease in mortality rate from 48% to 34% (p = 0.01). Mortality was significantly associated with older age, higher creatinine, lower lymphocyte count, and mean arterial pressure lower than 70 mm Hg on the day of admission.

References

Akando, Md, Department of Intensive Care

Argenziano, Bruce, Slater, Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: Retrospective case series, BMJ

Auld, Caridi-Scheible, Blum, ICU and ventilator mortality among critically ill adults with coronavirus disease 2019, Crit Care Med

Boccar, Md, Department of Intensive Care

Cavalcanti, Zampieri, Rosa, Hydroxychloroquine with or without azithromycin in mild-to-moderate Covid-19, N Engl J Med

Christophe, Dubois, Md, Department of Intensive Care

Cummings, Baldwin, Abrams, Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: A prospective cohort study, Lancet

Delanaye, Md, None

Fadel, Morrison, Vahia, Early short course corticosteroids in hospitalized patients with COVID-19, Clin Infect Dis

Grasselli, Zangrillo, Zanella, COVID-19 Lombardy ICU Network: Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy, JAMA

Gurdebeke, Md, Department of Intensive Care

Higny, Md, Department of Intensive Care

Horby, Lim, Emberson, Dexamethasone in hospitalized patients with Covid-19 -preliminary report, N Engl J Med

Lemineur, Md, Department of Intensive Care

Misset, Md, Department of Intensive Care

Quinonez, Md, Department of Intensive Care

Sterne, Murthy, Diaz, Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: A meta-analysis, JAMA

Villar, Ferrando, Martínez, Dexamethasone in ARDS Network: Dexamethasone treatment for the acute respiratory distress syndrome: A multicentre, randomised controlled trial, Lancet Respir Med

Wertz, Md, Department of Intensive Care

Yang, Yu, Xu, Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study, Lancet Respir Med

Late treatment
is less effective

Please send us corrections, updates, or comments. Vaccines and treatments are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.

Submit