Clinical characteristics of hospitalised patients with COVID-19 and the impact on mortality: a single-network, retrospective cohort study from Pennsylvania state
et al., BMJ Open, doi:10.1136/bmjopen-2020-042549, Apr 2021
Retrospective 283 patients in the USA showing higher mortality with all treatments (not statistically significant). Confounding by indication is likely. In the supplementary appendix, authors note that the treatments were usually given for patients that required oxygen therapy. Oxygen therapy and ICU admission (possibly, the paper includes ICU admission for model 2 in some places but not others) were the only variables indicating severity used in adjustments.
Standard of Care (SOC) for COVID-19 in the study country,
the USA, is very poor with very low average efficacy for approved treatments1.
Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
This study is excluded in the after exclusion results of meta-analysis:
substantial unadjusted confounding by indication likely.
|
risk of death, 72.8% higher, RR 1.73, p = 0.15, treatment 43 of 182 (23.6%), control 12 of 101 (11.9%), adjusted per study, odds ratio converted to relative risk, multivariate logistic regression.
|
| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
Gadhiya et al., 8 Apr 2021, retrospective, USA, peer-reviewed, 4 authors.
DOI record:
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"abstract": "<jats:sec><jats:title>Objective</jats:title><jats:p>COVID-19 is a respiratory disease caused by SARS-CoV-2 with the highest burden in the USA. Data on clinical characteristics of patients with COVID-19 in US population are limited. Thus, we aim to determine the clinical characteristics and risk factors for in-hospital mortality from COVID-19.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Retrospective observational study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Single-network hospitals in Pennsylvania state.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Patients with confirmed SARS-CoV-2 infection who were hospitalised from 1 March to 31 May 2020.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome measures</jats:title><jats:p>Primary outcome was in-hospital mortality. Secondary outcomes were complications, such as acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 283 patients, 19.4% were non-survivors. The mean age of all patients was 64.1±15.9 years. 56.2% were male and 50.2% were white. Several factors were identified from our adjusted multivariate analyses to be associated with in-hospital mortality: increasing age (per 1-year increment; OR 1.07 (1.045 to 1.105)), hypoxia (oxygen saturation <95%; OR 4.630 (1.934 to 1.111)), opacity/infiltrate on imaging (OR 3.077 (1.276 to 7.407)), leucocytosis (white blood cell >10<jats:sup>109/µL</jats:sup>; OR 2.732 (1.412 to 5.263)), ferritin >336 ng/mL (OR 4.016 (1.195 to 13.514)), lactate dehydrogenase >200 U/L (OR 7.752 (1.639 to 37.037)), procalcitonin >0.25 ng/mL (OR 2.404 (1.011 to 5.714)), troponin I >0.03 ng/mL (OR 2.242 (1.080 to 4.673)), need for advanced oxygen support other than simple nasal cannula (OR 4.608–13.889 (2.053 to 31.250)), intensive care unit admission/transfer (OR 13.699 (6.135 to 30.303)), renal replacement therapy (OR 21.277 (5.025 to 90.909)), need for vasopressor (OR 22.222 (9.434 to 52.632)), ARDS (OR 23.810 (10.204 to 55.556)), respiratory acidosis (OR 7.042 (2.915 to 16.949)), and AKI (OR 3.571 (1.715 to 7.407)). When critically ill patients were analysed independently, increasing Sequential Organ Failure Assessment score (OR 1.544 (1.168 to 2.039)), AKI (OR 2.128 (1.111 to 6.667)) and ARDS (OR 6.410 (2.237 to 18.182)) were predictive of in-hospital mortality.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>We reported the characteristics of ethnically diverse, hospitalised patients with COVID-19 from Pennsylvania state.</jats:p></jats:sec>",
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Late treatment
is less effective
is less effective
gadhiyaaz