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Characteristics and risk factors for mortality in critically ill patients with COVID-19 receiving invasive mechanical ventilation: the experience of a private network in Sao Paulo, Brazil

Osawa et al., The Journal of Critical Care Medicine, doi:10.2478/jccm-2022-0015
Jul 2022  
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Mortality 29% Improvement Relative Risk HCQ for COVID-19  Osawa et al.  VENTILATED PATIENTS Is late treatment with HCQ beneficial for COVID-19? Retrospective 215 patients in Brazil (March - October 2020) Lower mortality with HCQ (not stat. sig., p=0.07) c19hcq.org Osawa et al., The J. Critical Care Med.., Jul 2022 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.
4,400+ studies for 79 treatments. c19hcq.org
Retrospective 215 mechanically ventilated COVID-19 patients in Brazil, 71 treated with HCQ, showing lower mortality with treatment in unadjusted results, without statistical significance. Authors note HCQ was used more toward the start of the pandemic, which may introduce confounding due to overall protocols improving over time, suggesting that the actual benefit may be greater.
Although the 29% lower mortality is not statistically significant, it is consistent with the significant 26% lower mortality [22‑30%] from meta analysis of the 250 mortality results to date.
risk of death, 28.6% lower, RR 0.71, p = 0.07, treatment 25 of 71 (35.2%), control 71 of 144 (49.3%), NNT 7.1.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Osawa et al., 1 Jul 2022, retrospective, Brazil, peer-reviewed, mean age 62.7, 2 authors, study period 18 March, 2020 - 26 October, 2020. Contact: eduardo.osawa@imedgroup.com.br.
This PaperHCQAll
Characteristics and risk factors for mortality in critically ill patients with COVID-19 receiving invasive mechanical ventilation: the experience of a private network in Sao Paulo, Brazil
Eduardo Atsushi Osawa, Alexandre Toledo Maciel
The Journal of Critical Care Medicine, doi:10.2478/jccm-2022-0015
Introduction: The use of invasive mechanical ventilation (IMV) in COVID-19 represents in an incremental burden to healthcare systems. Aim of the study: We aimed to characterize patients hospitalized for COVID-19 who received IMV and identify risk factors for mortality in this population. Material and Methods: A retrospective cohort study including consecutive adult patients admitted to a private network in Brazil who received IMV from March to October, 2020. A bidirectional stepwise logistic regression analysis was used to determine the risk factors for mortality. Results: We included 215 patients, of which 96 died and 119 were discharged from ICU. The mean age was 62.7 ± 15.4 years and the most important comorbidities were hypertension (62.8%), obesity (50.7%) and diabetes (40%). Non-survivors had lower body mass index (BMI) (28.3 [25.5; 31.6] vs. 31.2 [28.3; 35], p<0.001, and a shorter duration from symptom onset to intubation (8.5 [6.0; 12] days vs. 10 [8.0; 12.5] days, p = 0.005). Multivariable regression analysis showed that the risk factors for mortality were age (OR: 1.07, 95% CI: 1.03 to 1.1, p < 0.001), creatinine level at the intubation date (OR: 3.28, 95% CI: 1.47 to 7.33, p = 0.004), BMI (OR: 0.91, 95% CI: 0.84 to 0.99, p = 0.033), lowest PF ratio within 48 hours post-intubation (OR: 0.988, 95% CI: 0.979 to 0.997, p = 0.011), barotrauma (OR: 5.18, 95% CI: 1.14 to 23.65, p = 0.034) and duration from symptom onset to intubation (OR: 0.76, 95% CI: 0.76 to 0.95, p = 0.006). Conclusion: In our retrospective cohort we identified the main risk factors for mortality in COVID-19 patients receiving IMV: age, creatinine at the day of intubation, BMI, lowest PF ratio 48-hours post-intubation, barotrauma and duration from symptom onset to intubation.
Conflict of interest None to declare.
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A ' 'bidirectional stepwise logistic regression analysis was used to determine the risk factors ' 'for mortality.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec id="j_jccm-2022-0015_s_009">\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>We included 215 patients, of which 96 died and 119 were discharged ' 'from ICU. The mean age was 62.7 ± 15.4 years and the most important comorbidities were ' 'hypertension (62.8%), obesity (50.7%) and diabetes (40%). Non-survivors had lower body mass ' 'index (BMI) (28.3 [25.5; 31.6] vs. 31.2 [28.3; 35], p&lt;0.001, and a shorter duration from ' 'symptom onset to intubation (8.5 [6.0; 12] days vs. 10 [8.0; 12.5] days, p = 0.005). ' 'Multivariable regression analysis showed that the risk factors for mortality were age (OR: ' '1.07, 95% CI: 1.03 to 1.1, p &lt; 0.001), creatinine level at the intubation date (OR: 3.28, ' '95% CI: 1.47 to 7.33, p = 0.004), BMI (OR: 0.91, 95% CI: 0.84 to 0.99, p = 0.033), lowest PF ' 'ratio within 48 hours post-intubation (OR: 0.988, 95% CI: 0.979 to 0.997, p = 0.011), ' 'barotrauma (OR: 5.18, 95% CI: 1.14 to 23.65, p = 0.034) and duration from symptom onset to ' 'intubation (OR: 0.76, 95% CI: 0.76 to 0.95, p = 0.006).</jats:p>\n' ' </jats:sec>\n' ' <jats:sec id="j_jccm-2022-0015_s_010">\n' ' <jats:title>Conclusion</jats:title>\n' ' <jats:p>In our retrospective cohort we identified the main risk factors for ' 'mortality in COVID-19 patients receiving IMV: age, creatinine at the day of intubation, BMI, ' 'lowest PF ratio 48-hours post-intubation, barotrauma and duration from symptom onset to ' 'intubation.</jats:p>\n' ' </jats:sec>', 'DOI': '10.2478/jccm-2022-0015', 'type': 'journal-article', 'created': {'date-parts': [[2022, 8, 22]], 'date-time': '2022-08-22T05:14:06Z', 'timestamp': 1661145246000}, 'page': '165-175', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Characteristics and risk factors for mortality in critically ill patients with COVID-19 ' 'receiving invasive mechanical ventilation: the experience of a private network in Sao Paulo, ' 'Brazil', 'prefix': '10.2478', 'volume': '8', 'author': [ { 'given': 'Eduardo Atsushi', 'family': 'Osawa', 'sequence': 'first', 'affiliation': [ {'name': 'Imed Group, Research Department , Sao Paulo Brazil'}, { 'name': 'Adult Intensive Care Unit, São Camilo Hospital , Sao Paulo ' 'Brazil'}]}, { 'given': 'Alexandre Toledo', 'family': 'Maciel', 'sequence': 'additional', 'affiliation': [ {'name': 'Imed Group, Research Department , Sao Paulo Brazil'}, { 'name': 'Adult Intensive Care Unit, São Camilo Hospital , Sao Paulo ' 'Brazil'}]}], 'member': '374', 'published-online': {'date-parts': [[2022, 8, 12]]}, 'reference': [ { 'key': '2022082221004419262_j_jccm-2022-0015_ref_001', 'doi-asserted-by': 'crossref', 'unstructured': 'Wang Y, Lu X, Li Y, Chen H, Chen T, Su N, et al. 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' 'Incidence of Barotrauma in Patients With COVID-19 Pneumonia During ' 'Prolonged Invasive Mechanical Ventilation- A Case-Control Study. J ' 'Intensive Care Med 2021;36(4):477-83.', 'DOI': '10.1177/0885066620954364'}, { 'key': '2022082221004419262_j_jccm-2022-0015_ref_039', 'doi-asserted-by': 'crossref', 'unstructured': 'Roden AC, Bois MC, Johnson TF, Aubry MC, Alexander MP, Hagen CE, et al. ' 'The Spectrum of Histopathologic Findings in Lungs of Patients With Fatal ' 'Coronavirus Disease 2019 (COVID-19) Infection. Arch Pathol Lab Med ' '2021;145(1):11-21.', 'DOI': '10.5858/arpa.2020-0491-SA'}, { 'key': '2022082221004419262_j_jccm-2022-0015_ref_040', 'doi-asserted-by': 'crossref', 'unstructured': 'Fahmy OH, Daas FM, Salunkhe V, Petrey JL, Cosar EF, Ramirez J, et al. Is ' 'Microthrombosis the Main Pathology in Coronavirus Disease 2019 ' 'Severity?-A Systematic Review of the Postmortem Pathologic Findings. 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Ann Am Thorac Soc ' '2017;14(11):1667-73.', 'DOI': '10.1513/AnnalsATS.201703-208OC'}, { 'key': '2022082221004419262_j_jccm-2022-0015_ref_044', 'doi-asserted-by': 'crossref', 'unstructured': 'Wunsch H. Mechanical Ventilation in COVID-19: Interpreting the Current ' 'Epidemiology. 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Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment 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.
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