Lambermont et al. HCQ for COVID-19 LATE TREATMENT
Predictors of Mortality and Effect of Drug Therapies in Mechanically Ventilated Patients With Coronavirus Disease 2019: A Multicenter Cohort Study
et al., Critical Care Explorations,
Predictors of Mortality and Effect of Drug Therapies in Mechanically Ventilated Patients With Coronavirus..
Critical Care Explorations, doi:10.1097/CCE.0000000000000305
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 22% lower mortality
from meta analysis of the
229 mortality results to date
risk of death, , treatment 97 of 225 (43.1%), control 14 of 22 (63.6%), NNT 4.9, adjusted per study.
32.3% lower, RR 0.68, p = 0.46
Effect extraction follows
pre-specified rules prioritizing more serious outcomes. Submit updates
Lambermont et al., 28 Nov 2020, retrospective, Belgium, peer-reviewed, 15 authors.
Abstract: Letter to the Editor
Predictors of Mortality and Effect of Drug
Therapies in Mechanically Ventilated Patients
With Coronavirus Disease 2019: A Multicenter
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
To the Editor:
ince the start of the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) pandemic, the World Health
Organization (WHO) has advocated for trials to assess the
benefit of antiviral treatment, anticytokine drugs, anti-inflammatory drugs, convalescent plasma, and hydroxychloroquine.
However, evidence of the efficacy of such strategies is still lacking, except for corticosteroid therapy. In particular, a before-after
study suggested a beneficial effect of methylprednisolone use
in patients with moderate-to-severe coronavirus disease 2019
(COVID-19) (1). The randomized evaluation of COVID-19 therapy (RECOVERY) trial recently showed dexamethasone resulted
in lower 28-day mortality among COVID-19 patients receiving
either invasive mechanical ventilation or oxygen (2). Following
Key Words: coronavirus; corticosteroids; critical care; mortality;
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these results, further studies comparing hydrocortisone or dexamethasone and placebo in COVID-19 patients were underpowered to find statistically significant reductions in mortality and
stopped early. These studies were then included in the WHO Rapid
Evidence Appraisal for COVID-19 Therapies (REACT) meta-analysis pooling data from seven randomized clinical trials and including 1,703 patients (3). This meta-analysis observed administration
is less effective
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