Differences in the severity and mortality risk factors for patients hospitalized for COVID-19 pneumonia between the early wave and the very late stage of the pandemic

Li et al., Frontiers in Medicine, doi:10.3389/fmed.2023.1238713

Sep 2023

Retrospective 223 hospitalized patients in China, showing no significant difference in mortality with paxlovid in unadjusted results.

Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid Hoertel. Retrospective studies that do not exclude contraindicated patients may significantly overestimate efficacy.

Black box warning. The FDA notes that "severe, life-threatening, and/or fatal adverse reactions due to drug interactions have been reported in patients treated with paxlovid" FDA.

This study is excluded in the after exclusion results of meta analysis: unadjusted results with minimal group details.

1. FDA, Fact sheet for healthcare providers: emergency use authorization for paxlovid, www.fda.gov/media/155050/download.fda.gov.

2. Hoertel et al., Prevalence of Contraindications to Nirmatrelvir-Ritonavir Among Hospitalized Patients With COVID-19 at Risk for Progression to Severe Disease, JAMA Network Open, doi:10.1001/jamanetworkopen.2022.42140.jamanetwork.com, doi.org.

Important missing comments or errors? Let us know.

risk of death, 17.8% lower, RR 0.82, p = 0.61, treatment 14 of 73 (19.2%), control 35 of 150 (23.3%), NNT 24.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Li et al., 28 Sep 2023, retrospective, China, peer-reviewed, 7 authors, study period 8 December, 2022 - 31 January, 2023. Contact: lihaiyan2128@163.com, siyuanlyl@163.com.

This Paper Paxlovid All

Differences in the severity and mortality risk factors for patients hospitalized for COVID-19 pneumonia between the early wave and the very late stage of the pandemic

Haiyan Li, Xiaoni Jia, Yu Wang, Yali Lv, Jing Wang, Yuyao Zhai, Xiaorong Xue

Frontiers in Medicine, doi:10.3389/fmed.2023.1238713

Background: Since China's dynamic zero-COVID policy is cancelled on December 7, 2022, the rapidly growing number of patients has brought a major public health challenge. This study aimed to assess whether there were differences in the severity and mortality risk factors for patients hospitalized for COVID-19 pneumonia between the early wave and the very late stage of the pandemic. Methods: A retrospective cross-sectional study was carried out using data from 223 hospitalized patients diagnosed with COVID-19 pneumonia during the Omicron surge in Xi'an People's Hospital (Xi'an Fourth Hospital) from December 8, 2022, to January 31, 2023. Univariable and multivariable logistic regression analyses were used to identify potential risk factors associated with the severity and mortality of COVID-19 pneumonia during the first wave of the pandemic after the dynamic zero-COVID policy was retracted. Differences in the severity and mortality risk factors were assessed at different stages of the pandemic, mainly from demographic, clinical manifestation, laboratory tests and radiological findings of patients on admission. Results: The mean age of the 223 participants was 71.2 ± 17.4. Compared with the patients in the initial stage of the pandemic, the most common manifestation among patients in this study was cough (90.6%), rather than fever (79.4%). Different from the initial stage of the pandemic, older age, chest tightness, elevated neutrophil-to-lymphocyte ratio (NLR), decreased albumin (ALB) level and ground glass opacification (GGO) in radiological finding were identified as severity risk factors, instead of mortality risk factors for COVID-19 patients in the very late stage of the pandemic. Arterial partial pressure of oxygen/fraction of inspired oxygen (PaO 2 /FiO 2 ) ≤300 mmHg, cardiovascular disease and laboratory findings including elevated levels of D-dimer, α-hydroxybutyrate dehydrogenase (α-HBDH), total bilirubin (TBIL), alanine aminotransferase (ALT), urea nitrogen (BUN), creatinine (CR), fasting blood glucose (FBG) and decreased platelet count (PLT) were still associated with mortality in the very late stage of the pandemic. Conclusion: Monitoring continuously differences in the severity and mortality risk factors for COVID-19 patients between different stages of the pandemic could

Ethics statement The studies involving humans were approved by the Ethical Committee of Xi'an People's Hospital (Xi'an Fourth Hospital) (No: 2023063). The studies were conducted in accordance with the local legislation and institutional requirements. The ethics committee/ institutional review board waived the requirement of written informed consent for participation from the participants or the participants' legal guardians/next of kin because patient informed consent was waived due to the retrospective study design. Author contributions HL and YL: conceptualization. HL, YZ, XX, YW, and JW: data collection. HL and XJ: analyze the data, software, and original draft. HL, XJ, and YZ: methodology. XX and YL: supervision. YZ and YL: critical revision of the manuscript. All authors have approved the final version of the manuscript. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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