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Factors associated with progression to critical illness in 28 days among COVID-19 patients: results from a tertiary care hospital in Istanbul, Turkey

Sili et al., medRxiv, doi:10.1101/2020.10.09.20209775
Oct 2020  
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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.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments. c19hcq.org
Analysis of hospitalized patients in Turkey showing HCQ was given to 99.2% of patients and the incidence of critical illness was lower than most studies. Authors note "whether HCQ administration lowered the rates of critical illness development is beyond the scope of this study." There is no comparison with a control group.
Sili et al., 11 Oct 2020, Turkey, preprint, 21 authors.
This PaperHCQAll
Factors associated with progression to critical illness in 28 days among COVID-19 patients: results from a tertiary care hospital in Istanbul, Turkey
MD Uluhan Sili, Pinar Ay, Ahmet Topuzoglu, Elif Huseyin Bilgin, Elif Tukenmez Tigen, Buket Erturk Sengel, Dilek Yagci Caglayik, Baran Balcan, Sehnaz Derya Kocakaya, Sehnaz Olgun Yildizeli, Fethi Gul, Beliz Bilgili, Rabia Can Sarinoglu, Aysegul Karahasan Yagci, Lutfiye Mulazimoglu Durmusoglu, Emel Eryuksel, Zekaver Odabasi, Haner Direskeneli, Sait Karakurt, Ismail Cinel, Volkan Korten
doi:10.1101/2020.10.09.20209775
Background Coronavirus disease 2019 quickly spread worldwide to become a pandemic. This study aimed to define the predictors of critical illness development within 28 days postadmission. Methods We conducted a prospective cohort study including 477 PCR-positive COVID-19 patients admitted to a tertiary care hospital in Istanbul from March 12 to May 12, 2020. The development of critical illness, e.g., invasive mechanical ventilation and/or death, was followed for a period of 28 days postadmission. Demographic characteristics, number of comorbidities, illness severity at admission defined by the WHO scale, vital signs, laboratory findings and period of admission to the hospital were independent variables. Cox proportional hazards analysis was performed, and the C-index was calculated. Results The median (IQR) age of the cohort was 55.0 (44.0-67.0) years, and 50.1% were male. The most common presenting symptoms were cough, dyspnea and fatigue. Overall, 65.2% of the patients had at least one comorbidity. Hydroxychloroquine was given to 99.2% of the patients. Critical illness developed in 45 (9.4%; 95% CI: 7.0%-12.4%) patients. In the multivariable analysis, age (HR: 1.05, p<0.001), number of comorbidities (HR: 1.33, p=0.02), procalcitonin ≥0.25 µg/L (HR: 2.12, p=0.03) and LDH ≥350 U/L (HR: 2.04, p=0.03) were .
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The development of ' 'critical illness, e.g., invasive mechanical ventilation and/or death, was followed for a ' 'period of 28 days postadmission. Demographic characteristics, number of comorbidities, ' 'illness severity at admission defined by the WHO scale, vital signs, laboratory findings and ' 'period of admission to the hospital were independent variables. Cox proportional hazards ' 'analysis was performed, and the C-index was ' 'calculated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The median ' '(IQR) age of the cohort was 55.0 (44.0-67.0) years, and 50.1% were male. The most common ' 'presenting symptoms were cough, dyspnea and fatigue. Overall, 65.2% of the patients had at ' 'least one comorbidity. Hydroxychloroquine was given to 99.2% of the patients. Critical ' 'illness developed in 45 (9.4%; 95% CI: 7.0%-12.4%) patients. In the multivariable analysis, ' 'age (HR: 1.05, p&lt;0.001), number of comorbidities (HR: 1.33, p=0.02), procalcitonin ≥0.25 ' 'µg/L (HR: 2.12, p=0.03) and LDH ≥350 U/L (HR: 2.04, p=0.03) were independently associated ' 'with critical illness development. The WHO scale on admission was the strongest predictor of ' 'critical illness (HR: 4.15, p&lt;0.001). Prognosis improved within the study period ' '(p&lt;0.05). The C-index of the model was ' '0.92.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Age, ' 'comorbidity number, WHO scale, LDH and procalcitonin were independently associated with ' 'critical illness development. Mortality from COVID-19 seems to be decreasing as the pandemic ' 'advances.</jats:p></jats:sec><jats:sec><jats:title>summary</jats:title><jats:p>We analyzed ' '477 confirmed COVID-19 patients for the development of critical illness, e.g., invasive ' 'mechanical ventilation and/or death within 28 days postadmission. 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