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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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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.

Lower risk for mortality, hospitalization, progression, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine treatments. ^* >10% efficacy, ≥3 studies.

4,500+ studies for 81 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.

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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 Paper HCQ All

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.\n' ' \n' ' \n' ' Results\n' ' 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). 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Acute kidney injury prevalence, progression and long-term outcomes ' 'in critically ill patients with COVID-19: a cohort study. Ann Intensive ' 'Care 2021;11(1):123.', 'DOI': '10.1186/s13613-021-00914-5'}, { 'key': '2022082221004419262_j_jccm-2022-0015_ref_031', 'doi-asserted-by': 'crossref', 'unstructured': 'Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute ' 'kidney injury in patients hospitalized with COVID-19. Kidney Int ' '2020;98(1):209-18.', 'DOI': '10.1016/j.kint.2020.05.006'}, { 'key': '2022082221004419262_j_jccm-2022-0015_ref_032', 'doi-asserted-by': 'crossref', 'unstructured': 'Bowe B, Cai M, Xie Y, Gibson AK, Maddukuri G, Al-Aly Z. Acute Kidney ' 'Injury in a National Cohort of Hospitalized US Veterans with COVID-19. 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' 'Pneumothorax in critically ill patients with COVID-19 infection: ' 'Incidence, clinical characteristics and outcomes in a case control ' 'multicenter study. Respir Med 2021;184:106464.', 'DOI': '10.1016/j.rmed.2021.106464'}, { 'key': '2022082221004419262_j_jccm-2022-0015_ref_036', 'doi-asserted-by': 'crossref', 'unstructured': 'Belletti A, Landoni G, Zangrillo A. Pneumothorax and barotrauma in ' 'invasively ventilated patients with COVID-19. Respir Med ' '2021;187:106552.', 'DOI': '10.1016/j.rmed.2021.106552'}, { 'key': '2022082221004419262_j_jccm-2022-0015_ref_037', 'doi-asserted-by': 'crossref', 'unstructured': 'Parker JC, Hernandez LA, Peevy KJ. Mechanisms of ventilator-induced lung ' 'injury. Crit Care Med 1993;21(1):131-43.', 'DOI': '10.1097/00003246-199301000-00024'}, { 'key': '2022082221004419262_j_jccm-2022-0015_ref_038', 'doi-asserted-by': 'crossref', 'unstructured': 'Udi J, Lang CN, Zotzmann V, Krueger K, Fluegler A, Bamberg F, et al. ' '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. Am J Respir Crit Care Med 2020;202(1):1-4.', 'DOI': '10.1164/rccm.202004-1385ED'}], 'container-title': 'The Journal of Critical Care Medicine', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.sciendo.com/pdf/10.2478/jccm-2022-0015', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 8, 22]], 'date-time': '2022-08-22T21:01:13Z', 'timestamp': 1661202073000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.sciendo.com/article/10.2478/jccm-2022-0015'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2022, 7, 1]]}, 'references-count': 44, 'journal-issue': { 'issue': '3', 'published-online': {'date-parts': [[2022, 8, 12]]}, 'published-print': {'date-parts': [[2022, 8, 12]]}}, 'alternative-id': ['10.2478/jccm-2022-0015'], 'URL': 'http://dx.doi.org/10.2478/jccm-2022-0015', 'relation': {}, 'ISSN': ['2393-1817'], 'subject': ['General Mathematics'], 'published': {'date-parts': [[2022, 7, 1]]}}

Late treatment
is less effective

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