Agentes terapéuticos utilizados en 238 pacientes hospitalizados por COVID-19 y su relación con la mortalidad
Mario Rivera-Izquierdo, María Del Carmen Valero-Ubierna, Juan Luis R-Delamo, Miguel Ángel Fernández-García, Silvia Martínez-Diz, Arezu Tahery-Mahmoud, Marta Rodríguez-Camacho, Ana Belén Gámiz-Molina, Nicolás Barba-Gyengo, Pablo Gámez-Baeza, Celia Cabrero-Rodríguez, Pedro Antonio Guirado-Ruiz, Divina Tatiana Martín-Romero, Antonio Jesús Láinez-Ramos-Bossini, María Rosa Sánchez-Pérez, José Mancera-Romero, Miguel García-Martín, Luis Miguel Martín-Delosreyes, Virginia Martínez-Ruiz, Eladio Jiménez-Mejías
Medicina Clínica, doi:10.1016/j.medcli.2020.06.025
Antecedentes y objetivo: En los últimos meses se han realizado grandes esfuerzos para evaluar las terapias más eficaces en el manejo de pacientes con COVID-19. Actualmente ninguna combinación ha demostrado de manera consistente una relación clara con la mortalidad. Nuestro objetivo fue valorar el patrón de asociaciones observado entre los distintos tratamientos intrahospitalarios administrados a 238 pacientes ingresados por COVID-19 y la mortalidad. Materiales y métodos: Se analizaron las historias clínicas electrónicas de aquellos pacientes dados de alta o que fallecieron por COVID-19 entre el 16 de marzo y el 10 de abril de 2020 en el Hospital Universitario San Cecilio (Granada, Espa ña). Se obtuvo información sobre sexo, edad, comorbilidades al ingreso, parámetros clínicos, analíticos, pruebas de imagen y tratamientos empíricos empleados. La variable de desenlace fue la mortalidad intrahospitalaria. Para estimar las asociaciones entre los diferentes tratamientos y el riesgo de mortalidad se estimaron, mediante modelos de regresión de Cox, hazard ratio ajustadas por edad, sexo, patologías previas y gravedad al ingreso. Resultados: La combinación de fármacos más frecuentemente empleada fue la formada por heparina de bajo peso molecular (HBPM), hidroxicloroquina y ritonavir/lopinavir. Ninguno de los tratamientos utilizados mostró una asociación independiente con la mortalidad. Los fármacos que mostraron una asociación inversa de mayor magnitud fueron el tocilizumab y los corticoides. Conclusiones: El patrón se asociaciones obtenido es consistente con lo reportado en la bibliografía. Parece oportuno dise ñar ensayos aleatorizados que valoren el posible efecto protector de los corticoides y el tocilizumab sobre el riesgo de muerte en algunos subgrupos de pacientes hospitalizados por COVID-19.
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