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0 0.5 1 1.5 2+ Mortality 32% Improvement Relative Risk Mortality (b) 37% Mortality (c) 34% HCQ for COVID-19  Ñamendys-Silva et al.  ICU PATIENTS Is very late treatment with HCQ beneficial for COVID-19? Retrospective 164 patients in Mexico Lower mortality with HCQ (not stat. sig., p=0.19) Ñamendys-Silva et al., Heart & Lung, Oct 2020 Favors HCQ Favors control

Outcomes of patients with COVID-19 in the Intensive Care Unit in Mexico: A multicenter observational study

Ñamendys-Silva et al., Heart & Lung, doi:10.1016/j.hrtlng.2020.10.013
Oct 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now known with p < 0.00000000001 from 421 studies, recognized in 42 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
Retrospective 164 ICU patients in Mexico showing 32% lower mortality with HCQ+AZ and 37% lower with CQ.
HCQ+AZ vs. neither HCQ or CQ relative risk RR 0.68, p = 0.03
CQ vs. neither HCQ or CQ relative risk RR 0.63, p = 0.02
HCQ+AZ or CQ vs. neither relative risk RR 0.65, p = 0.006
risk of death, 32.3% lower, RR 0.68, p = 0.18, treatment 24 of 54 (44.4%), control 42 of 64 (65.6%), NNT 4.7, HCQ+AZ vs. neither HCQ or CQ.
risk of death, 37.1% lower, RR 0.63, p = 0.09, treatment 19 of 46 (41.3%), control 42 of 64 (65.6%), NNT 4.1, CQ vs. neither HCQ or CQ.
risk of death, 34.5% lower, RR 0.66, p = 0.006, treatment 43 of 100 (43.0%), control 42 of 64 (65.6%), NNT 4.4, HCQ+AZ or CQ.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ñamendys-Silva et al., 21 Oct 2020, retrospective, database analysis, Mexico, peer-reviewed, mean age 57.3, 18 authors, average treatment delay 7.0 days.
This PaperHCQAll
Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study
Silvio A Ñamendys-Silva, Pedro E Alvarado-Ávila, MD, FCCM Guillermo Domínguez-Cherit, MD Eduardo Rivero-Sigarroa, Luis A Sánchez-Hurtado, Alan Gutiérrez-Villaseñor, Juan P Romero-González, MD a , Heber Rodríguez-Bautista, MD Alondra García-Briones, César E Garnica-Camacho, Néstor G Cruz-Ruiz, María O González-Herrera, Francisco J García-Guillén, Manuel A Guerrero-Gutiérrez, José D Salmerón-González, Laura Romero-Gutiérrez, José L Canto-Castro, MD k , Victor H Cervantes
Heart & Lung, doi:10.1016/j.hrtlng.2020.10.013
Background: As of June 15, 2020, a cumulative total of 7,823,289 confirmed cases of COVID-19 have been reported across 216 countries and territories worldwide. However, there is little information on the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to intensive care units (ICUs) in Latin America. The present study evaluated the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to ICUs in Mexico. Methods: This was a multicenter observational study that included 164 critically ill patients with laboratoryconfirmed COVID-19 who were admitted to 10 ICUs in Mexico, from April 1 to April 30, 2020. Demographic data, comorbid conditions, clinical presentation, treatment, and outcomes were collected and analyzed. The date of final follow-up was June 4, 2020. Results: A total of 164 patients with severe COVID-19 were included in this study. The mean age of patients was 57.3 years (SD 13.7), 114 (69.5%) were men, and 6.0% were healthcare workers. Comorbid conditions were common in patients with critical COVID-19: 38.4% of patients had hypertension and 32.3% had diabetes. Compared to survivors, nonsurvivors were older and more likely to have diabetes, hypertension or other conditions. Patients presented to the hospital a median of 7 days (IQR 4.5À9) after symptom onset. The most common presenting symptoms were shortness of breath, fever, dry cough, and myalgias. One hundred percent of patients received invasive mechanical ventilation for a median time of 11 days (IQR 6À14). A total of 139 of 164 patients (89.4%) received vasopressors, and 24 patients (14.6%) received renal replacement therapy during hospitalization. Eighty-five (51.8%) patients died at or before 30 days, with a median survival of 25 days. Age (OR, 1.05; 95% CI, 1.02À1.08; p<0.001) and C-reactive protein levels upon ICU admission (1.008; 95% CI, 1.003À1.012; p<0.001) were associated with a higher risk of in-hospital death. ICU length of stay was associated with reduced in-hospital mortality risk (OR, 0.89; 95% CI, 0.84À0.94; p<0.001).
Author contributions Dr e Namendys-Silva had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: e Namendys-Silva, Dominguez-Cherit Acquisition of data: All authors Statistical analysis: e Namendys-Silva. Drafting of the manuscript: e Namendys-Silva, Alvarado-Avila, Dominguez-Cherit, Rivero-Sigarroa Critical revision of the manuscript for important intellectual content: All authors. Declarations of Competing Interest The authors state that there are no conflicts of interest related to this study. Supplementary materials Supplementary material associated with this article can be found in the online version at doi:10.1016/j.hrtlng.2020.10.013.
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Late treatment
is less effective
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