Observational Study on 255 Mechanically Ventilated Covid Patients at the Beginning of the USA Pandemic
Leon G Smith, Nicolas Mendoza, David Dobesh, Stephen M Smith
doi:10.1101/2021.05.28.21258012
All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
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'abstract': '<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>This '
'observational study looked at 255 COVID19 patients who required invasive mechanical '
'ventilation (IMV) during the first two months of the US pandemic. Through comprehensive, '
'longitudinal evaluation and new consideration of all the data, we were able to better '
'describe and understand factors affecting outcome after '
'intubation.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>All vital '
'signs, laboratory values, and medication administrations (time, date, dose, and route) were '
'collected and organized. Further, each patient’s prior medical records, including PBM data '
'and available ECG, were reviewed by a physician. These data were incorporated into '
'time-series database for statistical '
'analysis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>By discharge '
'or Day 90, 78.2% of the cohort expired. The most common pre-existing conditions were '
'hypertension, (63.5%), diabetes (59.2%) and obesity (50.4%). Age correlated with death. '
'Comorbidities and clinical status on presentation were not predictive of outcome. Admission '
'markers of inflammation were universally elevated (>96%). The cohort’s weight range was '
'nearly 7-fold. Causal modeling establishes that weight-adjusted HCQ and AZM therapy improves '
'survival by over 100%. QTc prolongation did not correlate with cumulative HCQ dose or HCQ '
'serum levels.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>This '
'detailed approach gives us better understanding of risk factors, prognostic indicators, and '
'outcomes of Covid patients needing IMV. Few variables were related to outcome. By considering '
'more factors and using new methods, we found that when increased doses of co-administered HCQ '
'and AZM were associated with >100% increase in survival. Comparison of absolute with '
'weight-adjusted cumulative doses proves administration ≥80 mg/kg of HCQ with > 1 gm AZM '
'increases survival in IMV-requiring Covid patients by over 100%. According to our data, HCQ '
'is not associated with prolongation. Studies, which reported QTc prolongation secondary to '
'HCQ, need to be re-evaluated more stringently and with controls.</jats:p><jats:p>The weight '
'ranges of Covid patient cohorts are substantially greater than those of most antibiotic RCTs. '
'Future clinical trials need to consider the weight variance of hospitalized Covid patients '
'and need to study therapeutics more thoughtfully.</jats:p></jats:sec>',
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