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All Studies   Meta Analysis    Recent:   

Clinical course and outcome of COVID-19 acute respiratory distress syndrome: data from a national repository

Solh et al., medRxiv, doi:10.1101/2020.10.16.20214130
Oct 2020  
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Mortality -18% Improvement Relative Risk HCQ for COVID-19  Solh et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 643 patients in the USA Higher mortality with HCQ (not stat. sig., p=0.17) c19hcq.org Solh et al., medRxiv, October 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
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.
4,300+ studies for 75 treatments. c19hcq.org
Retrospective database analysis of 7,816 Veterans Affairs hospitalized patients analyzing progression to ARDS and 30-day mortality from ARDS. Confounding by indication is likely. Chronological bias is likely, with HCQ more likely to be used earlier on, before significant improvements in overall treatment. No results are provided for HCQ for progression to ARDS.
This study is excluded in the after exclusion results of meta analysis: very late stage, >50% on oxygen/ventilation at baseline; substantial unadjusted confounding by indication likely.
risk of death, 18.0% higher, HR 1.18, p = 0.17, treatment 131 of 265 (49.4%), control 134 of 378 (35.4%), adjusted per study.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Solh et al., 20 Oct 2020, retrospective, database analysis, USA, preprint, 5 authors.
This PaperHCQAll
CLINICAL COURSE AND OUTCOME OF COVID-19 ACUTE RESPIRATORY DISTRESS SYNDROME: DATA FROM A NATIONAL REPOSITORY
MD, MPH Ali A El-Solh, MD Umberto G Meduri, MS Yolanda Lawson, PharmD Michael Carter, PharmD Kari A Mergenhagen
doi:10.1101/2020.10.16.20214130
Background: Mortality attributable to coronavirus disease-19 (COVID-19) 2 infection occurs mainly through the development of viral pneumonia-induced acute respiratory distress syndrome (ARDS). Research Question: The objective of the study is to delineate the clinical profile, predictors of disease progression, and 30-day mortality from ARDS using the Veterans Affairs Corporate Data Warehouse. Study Design and Methods: Analysis of a historical cohort of 7,816 hospitalized patients with confirmed COVID-19 infection between January 1, 2020, and August 1, 2020. Main outcomes were progression to ARDS and 30-day mortality from ARDS, respectively. Results: The cohort was comprised predominantly of men (94.5%) with a median age of 69 years (interquartile range [IQR] 60-74 years). 2,184 (28%) were admitted to the intensive care unit and 643 (29.4%) were diagnosed with ARDS. The median Charlson Index was 3 (IQR 1-5). Independent predictors of progression to ARDS were body mass index (BMI)≥ 40 kg/m 2 , diabetes, lymphocyte counts<700x109/L, LDH>450 U/L, ferritin >862 ng/ml, C-reactive protein >11 mg/dL, and Ddimer >1.5 ug/ml. In contrast, the use of an anticoagulant lowered the risk of developing ARDS (OR 0.66 [95% CI 0.49-0.89]. Crude 30-day mortality rate from ARDS was 41% (95% CI 38%-45%). Risk of death from ARDS was significantly higher in those who developed acute renal failure and septic shock. Use of an anticoagulant was associated with two-fold reduction in mortality. Survival benefit was observed in patients who received corticosteroids and/or remdesivir but there was no advantage of combination therapy over either agent alone. Conclusions: Among those hospitalized for COVID-19, nearly one in ten progressed to ARDS. Septic shock, and acute renal failure are the leading causes of death in these patients. Treatment with either remdesivir and corticosteroids reduced the risk of mortality from ARDS. All hospitalized patients with COVID-19 should be placed at a minimum on prophylactic doses of anticoagulation. .
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Main outcomes ' 'were progression to ARDS and 30-day mortality from ARDS, ' 'respectively.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The cohort ' 'was comprised predominantly of men (94.5%) with a median age of 69 years (interquartile range ' '[IQR] 60-74 years). 2,184 (28%) were admitted to the intensive care unit and 643 (29.4%) were ' 'diagnosed with ARDS. The median Charlson Index was 3 (IQR 1-5). Independent predictors of ' 'progression to ARDS were body mass index (BMI)≥ 40 kg/m<jats:sup>2</jats:sup>, diabetes, ' 'lymphocyte counts&lt;700×109/L, LDH&gt;450 U/L, ferritin &gt;862 ng/ml, C-reactive protein ' '&gt;11 mg/dL, and D-dimer &gt;1.5 ug/ml. In contrast, the use of an anticoagulant lowered the ' 'risk of developing ARDS (OR 0.66 [95% CI 0.49-0.89]. Crude 30-day mortality rate from ARDS ' 'was 41% (95% CI 38%-45%). Risk of death from ARDS was significantly higher in those who ' 'developed acute renal failure and septic shock. Use of an anticoagulant was associated with ' 'two-fold reduction in mortality. Survival benefit was observed in patients who received ' 'corticosteroids and/or remdesivir but there was no advantage of combination therapy over ' 'either agent ' 'alone.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Among those ' 'hospitalized for COVID-19, nearly one in ten progressed to ARDS. Septic shock, and acute ' 'renal failure are the leading causes of death in these patients. Treatment with either ' 'remdesivir and corticosteroids reduced the risk of mortality from ARDS. 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Effect of Dexamethasone ' 'on Days Alive and Ventilator-Free in Patients With Moderate or Severe ' 'Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized ' 'Clinical Trial. JAMA. Sep 2 2020.', 'DOI': '10.1001/jama.2020.17021'}, { 'key': '2020102212050594000_2020.10.16.20214130v1.42', 'unstructured': 'Writing Committee for the R-CAPI, Angus DC , Derde L , et al. Effect of ' 'Hydrocortisone on Mortality and Organ Support in Patients With Severe ' 'COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized ' 'Clinical Trial. JAMA. Sep 2 2020.'}, { 'key': '2020102212050594000_2020.10.16.20214130v1.43', 'unstructured': 'Coronavirus (COVID-19) update: FDA issues emergency use authorization ' 'for potential COVID-19 treatment. Available at: ' 'https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-potential-covid-19-treatment. ' 'Accessed Septmeber 30, 2020.'}, { 'key': '2020102212050594000_2020.10.16.20214130v1.44', 'unstructured': 'Beigel JH , Tomashek KM , Dodd LE , et al. Remdesivir for the Treatment ' 'of Covid-19 - Preliminary Report. N Engl J Med. May 22 2020.'}], 'container-title': [], 'original-title': [], 'link': [ { 'URL': 'https://syndication.highwire.org/content/doi/10.1101/2020.10.16.20214130', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 11, 24]], 'date-time': '2022-11-24T02:03:46Z', 'timestamp': 1669255426000}, 'score': 1, 'resource': {'primary': {'URL': 'http://medrxiv.org/lookup/doi/10.1101/2020.10.16.20214130'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2020, 10, 20]]}, 'references-count': 44, 'URL': 'http://dx.doi.org/10.1101/2020.10.16.20214130', 'relation': {}, 'published': {'date-parts': [[2020, 10, 20]]}, 'subtype': 'preprint'}
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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