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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

El-Solh et al., Journal of Intensive Care Medicine, doi:10.1177/0885066621994476 (date from preprint)
Oct 2020  
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Mortality 29% Improvement Relative Risk Remdesivir  El-Solh et al.  LATE TREATMENT Is late treatment with remdesivir beneficial for COVID-19? Retrospective 643 patients in the USA Lower mortality with remdesivir (p=0.031) c19early.org El-Solh et al., J. Intensive Care Medi.., Oct 2020 Favorsremdesivir Favorscontrol 0 0.5 1 1.5 2+
Retrospective 7,816 Veterans Affairs hospitalized patients showing lower mortality with remdesivir.
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: very late stage, >50% on oxygen/ventilation at baseline; substantial unadjusted confounding by indication likely; significant confounding by contraindications possible.
risk of death, 29.0% lower, HR 0.71, p = 0.03, treatment 63 of 219 (28.8%), control 202 of 424 (47.6%), NNT 5.3, adjusted per study, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
El-Solh et al., 20 Oct 2020, retrospective, database analysis, USA, peer-reviewed, 5 authors.
This PaperRemdesivirAll
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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' '</jats:p></jats:sec><jats:sec><jats:title>Research Question:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Study Design and ' 'Methods:</jats:title><jats:p> 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. ' '</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 2-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 1 in 10 progressed to ARDS. 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Late treatment
is less effective
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