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Clinical and laboratory characteristics of patients hospitalized with severe COVID-19 in New Orleans, August 2020 to September 2021

Drouin et al., Scientific Reports, doi:10.1038/s41598-024-57306-5
Mar 2024  
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Severe case -46% Improvement Relative Risk Remdesivir for COVID-19  Drouin et al.  LATE TREATMENT Is late treatment with remdesivir beneficial for COVID-19? Retrospective 456 patients in the USA (August 2020 - September 2021) Higher severe cases with remdesivir (p<0.000001) c19early.org Drouin et al., Scientific Reports, Mar 2024 Favorsremdesivir Favorscontrol 0 0.5 1 1.5 2+
Retrospective 456 hospitalized patients in the USA showing an association between remdesivir treatment and increased COVID-19 severity in multivariable analysis, for remdesivir treatment within 7 days and when administered before meeting the severe case definition. Authors suggest this is due to remdesivir being preferentially used for more severe cases, citing Bhimraj et al., however that paper is from April 2020 before widespread use of remdesivir. During the period of the current study remdesivir was more widely recommended. However, there could still be significant residual confounding after adjustments.
Gérard, Zhou, Wu show significantly increased risk of acute kidney injury with remdesivir.
This study is excluded in the after exclusion results of meta analysis: substantial unadjusted confounding by indication likely.
risk of severe case, 46.4% higher, RR 1.46, p < 0.001, treatment 52 of 102 (51.0%), control 135 of 354 (38.1%), adjusted per study, odds ratio converted to relative risk, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Drouin et al., 19 Mar 2024, retrospective, USA, peer-reviewed, median age 56.0, 13 authors, study period August 2020 - September 2021. Contact: dfusco@tulane.edu.
This PaperRemdesivirAll
Clinical and laboratory characteristics of patients hospitalized with severe COVID-19 in New Orleans, August 2020 to September 2021
Arnaud Drouin, Ian D Plumb, Matthew Mccullough, Jade James Gist, Sharon Liu, Marc Theberge, Joshua Katz, Matthew Moreida, Shelby Flaherty, Bhoomija Chatwani, Melissa Briggs Hagen, Claire M Midgley, Dahlene Fusco
Scientific Reports, doi:10.1038/s41598-024-57306-5
Louisiana experienced high morbidity and mortality from COVID-19. To assess possible explanatory factors, we conducted a cohort study (ClinSeqSer) of patients hospitalized with COVID-19 in New Orleans during August 2020-September 2021. Following enrollment, we reviewed medical charts, and performed SARS-CoV-2 RT-PCR testing on nasal and saliva specimens. We used multivariable logistic regression to assess associations between patient characteristics and severe illness, defined as ≥ 6 L/min oxygen or intubation. Among 456 patients, median age was 56 years, 277 (60.5%) were Black non-Hispanic, 436 (95.2%) had underlying health conditions, and 358 were unvaccinated (92.0% of 389 verified). Overall, 187 patients (40.1%) had severe illness; 60 (13.1%) died during admission. In multivariable models, severe illness was associated with age ≥ 65 years (OR 2.08, 95% CI 1.22-3.56), hospitalization > 5 days after illness onset (OR 1.49, 95% CI 1.01-2.21), and SARS CoV-2 cycle threshold (Ct) result of < 32 in saliva (OR 4.79, 95% CI 1.22-18.77). Among patients who were predominantly Black non-Hispanic, unvaccinated and with underlying health conditions, approximately 1 in 3 patients had severe COVID-19. Older age and delayed time to admission might have contributed to high case-severity. An association between case-severity and low Ct value in saliva warrants further investigation. Keywords COVID-19,
Ethical approval This study was reviewed and approved by the Tulane University School of Medicine Institutional Review Board, and was performed in accordance with relevant guidelines (see 45 C.F.R. part 46; 21 C.F.R. part 56). Informed consent was obtained from all participants and/or their legal guardians. Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC). Author contributions The analysis was planned by A.D, D.F., I.P., and C.M. with input from other coauthors. Data preparation and analysis was conducted by D.F., M.M., and J.J.G. Data interpretation was conducted by D.F., C.M., and I.P. and manuscript writing was completed by D.F. and I.P. with critical input from all authors. D.F. had full access to all the data in the study and takes responsibility for the integrity of the data. All authors certify that they meet authorship criteria. Competing interests DF has served on an Advisory Board for Gilead Sciences and for AXCELLA, and as site PI for clinical trials sponsored by Gilead Sciences, Regeneron, MetroBiotech LLC, and the NIH (DMID COVAIL). AD has served as co site-PI on clinical trials sponsored by Gilead Sciences, Regeneron, MetroBiotech LLC, and the NIH (DMID COVAIL). Other authors declare that they have no conflict of interest.
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Saliva or nasopharyngeal swab specimens for ' 'detection of SARS-CoV-2. N. Engl. J. Med. 383(13), 1283–1286 (2020).', 'journal-title': 'N. Engl. J. Med.'}, { 'key': '57306_CR35', 'unstructured': 'Julio, S. et al. Saliva viral load is a dynamic unifying correlate of ' 'COVID-19 severity and mortality. medRxiv 2021.01.04.21249236 (2021).'}, { 'issue': '6', 'key': '57306_CR36', 'doi-asserted-by': 'publisher', 'first-page': '917.e1', 'DOI': '10.1016/j.cmi.2021.02.029', 'volume': '27', 'author': 'E Goldberg', 'year': '2021', 'unstructured': 'Goldberg, E. et al. A real-life setting evaluation of the effect of ' 'remdesivir on viral load in COVID-19 patients admitted to a large ' 'tertiary centre in Israel. Clin. Microbiol. Infect. 27(6), 917.e1-917.e4 ' '(2021).', 'journal-title': 'Clin. Microbiol. 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Epidemiol.'}], 'container-title': 'Scientific Reports', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.nature.com/articles/s41598-024-57306-5.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://www.nature.com/articles/s41598-024-57306-5', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://www.nature.com/articles/s41598-024-57306-5.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2024, 3, 19]], 'date-time': '2024-03-19T06:54:35Z', 'timestamp': 1710831275000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.nature.com/articles/s41598-024-57306-5'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2024, 3, 19]]}, 'references-count': 44, 'journal-issue': {'issue': '1', 'published-online': {'date-parts': [[2024, 12]]}}, 'alternative-id': ['57306'], 'URL': 'http://dx.doi.org/10.1038/s41598-024-57306-5', 'relation': { 'has-preprint': [ { 'id-type': 'doi', 'id': '10.21203/rs.3.rs-3773246/v1', 'asserted-by': 'object'}]}, 'ISSN': ['2045-2322'], 'subject': ['Multidisciplinary'], 'container-title-short': 'Sci Rep', 'published': {'date-parts': [[2024, 3, 19]]}, 'assertion': [ { 'value': '18 December 2023', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '17 March 2024', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '19 March 2024', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': 'DF has served on an Advisory Board for Gilead Sciences and for AXCELLA, and as ' 'site PI for clinical trials sponsored by Gilead Sciences, Regeneron, ' 'MetroBiotech LLC, and the NIH (DMID COVAIL). AD has served as co site-PI on ' 'clinical trials sponsored by Gilead Sciences, Regeneron, MetroBiotech LLC, and ' 'the NIH (DMID COVAIL). Other authors declare that they have no conflict of ' 'interest.', 'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '6539'}
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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