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0 0.5 1 1.5 2+ Mortality -45% Improvement Relative Risk HCQ for COVID-19  Sarfaraz et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 186 patients in Pakistan Higher mortality with HCQ (not stat. sig., p=0.068) Sarfaraz et al., medRxiv, January 2021 Favors HCQ Favors control

Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

Sarfaraz et al., medRxiv, doi:10.1101/2020.12.28.20248920
Jan 2021  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now known with p < 0.00000000001 from 422 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.
4,000+ studies for 60+ treatments.
Retrospective 186 hospitalized patients in Pakistan showing unadjusted HCQ mortality RR 1.45, p = 0.07. Confounding by indication is likely.
This study is excluded in the after exclusion results of meta analysis: substantial unadjusted confounding by indication likely; significant unadjusted confounding possible; unadjusted results with no group details.
risk of death, 45.0% higher, RR 1.45, p = 0.07, treatment 40 of 94 (42.6%), control 27 of 92 (29.3%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Sarfaraz et al., 2 Jan 2021, retrospective, Pakistan, preprint, 7 authors, average treatment delay 7.0 days.
This PaperHCQAll
Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan
Samreen Sarfaraz, Quratulain Shaikh, Syed Ghazanfar Saleem, Anum Rahim, Fivzia Farooq Herekar, Samina Junejo, Aneela Hussain
A prospective cohort study was conducted at the Indus Hospital Karachi, Pakistan between March and June 2020 to describe the determinants of mortality among hospitalized COVID-19 patients. 186 adult patients were enrolled and all-cause mortality was found to be 36% (67/186). Those who died were older and more likely to be males (p<0.05). Temperature and respiratory rate were higher among non-survivors while Oxygen saturation was lower (p<0.05). Serum CRP, D-dimer and IL-6 were higher while SpO2 was lower on admission among non-survivors (p<0.05). Non-survivors had higher SOFA and CURB-65 scores while thrombocytopenia, lymphopenia and severe ARDS was more prevalent among them (p<0.05). Use of non-invasive ventilation in emergency room, ICU admission and invasive ventilation were associated with mortality in our cohort (p<0.05). Length of hospital stay and days of intubation were longer in non-survivors (p<0.05). Use of azithromycin, hydroxychloroquine, steroids, tocilizumab, antibiotics, IVIG or anticoagulation showed no mortality benefit (p>0.05). Multivariable logistic regression showed that age > 60 years, oxygen saturation <93% on admission, pro-calcitonin > 2 ng/ml, unit rise in temperature and SOFA score, ICU admission and sepsis during hospital stay were associated with higher odds of mortality. Larger prospective studies are needed to further strengthen these findings.
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Youthful, Conservative Pakistan Is a Coronavirus Bright Spot
Late treatment
is less effective
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