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0 0.5 1 1.5 2+ Mortality -32% Improvement Relative Risk Vitamin C for COVID-19  Mulhem et al.  LATE TREATMENT Is late treatment with vitamin C beneficial for COVID-19? Retrospective 3,219 patients in the USA Higher mortality with vitamin C (p=0.011) Mulhem et al., BMJ Open, April 2021 Favors vitamin C Favors control

3219 hospitalised patients with COVID-19 in Southeast Michigan: a retrospective case cohort study

Mulhem et al., BMJ Open, doi:10.1136/bmjopen-2020-042042
Apr 2021  
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Retrospective database analysis of 3,219 hospitalized patients in the USA. Very different results in the time period analysis (Table S2), and results significantly different to other studies for the same medications (e.g., heparin OR 3.06 [2.44-3.83]) suggest significant confounding by indication and confounding by time.
This is the 19th of 64 COVID-19 controlled studies for vitamin C, which collectively show efficacy with p=0.00000022. 17 studies are RCTs, which show efficacy with p=0.00000014. This study is excluded in the after exclusion results of meta analysis: substantial unadjusted confounding by indication likely; substantial confounding by time likely due to declining usage over the early stages of the pandemic when overall treatment protocols improved dramatically.
This study includes aspirin, zinc, vitamin C, remdesivir, and HCQ.
risk of death, 32.2% higher, RR 1.32, p = 0.01, treatment 157 of 794 (19.8%), control 359 of 2,425 (14.8%), adjusted per study, odds ratio converted to relative risk, logistic regression.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Mulhem et al., 7 Apr 2021, retrospective, database analysis, USA, peer-reviewed, 3 authors.
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3219 hospitalised patients with COVID-19 in Southeast Michigan: a retrospective case cohort study
Dr Elie Mulhem, Andrew Oleszkowicz, David Lick
BMJ Open, doi:10.1136/bmjopen-2020-042042
Objective To report the clinical characteristics of patients hospitalised with COVID-19 in Southeast Michigan. Design Retrospective cohort study. Setting Eight hospitals in Southeast Michigan. Participants 3219 hospitalised patients with a positive SARS-CoV-2 infection by nasopharyngeal PCR test from 13 March 2020 until 29 April 2020. Main outcomes measures Outcomes were discharge from the hospital or in-hospital death. Examined predictors included patient demographics, chronic diseases, home medications, mechanical ventilation, in-hospital medications and timeframe of hospital admission. Multivariable logistic regression was conducted to identify risk factors for in-hospital mortality. Results During the study period, 3219 (90.4%) patients were discharged or died in the hospital. The median age was 65.2 (IQR 52.6-77.2) years, the median length of stay in the hospital was 6.0 (IQR 3.2-10.1) days, and 51% were female. Hypertension was the most common chronic disease, occurring in 2386 (74.1%) patients. Overall mortality rate was 16.0%. Blacks represented 52.3% of patients and had a mortality rate of 13.5%. Mortality was highest at 18.5% in the prepeak hospital COVID-19 volume, decreasing to 15.3% during the peak period and to 10.8% in the postpeak period. Multivariable regression showed increasing odds of in-hospital death associated with older age (OR 1.04, 95% CI 1.03 to 1.05, p<0.001) for every increase in 1 year of age and being male (OR 1.47, 95% CI 1.21 to 1.81, p<0.001). Certain chronic diseases increased the odds of in-hospital mortality, especially chronic kidney disease. Administration of vitamin C, corticosteroids and therapeutic heparin in the hospital was associated with higher odds of death. Conclusion In-hospital mortality was highest in early admissions and improved as our experience in treating patients with COVID-19 increased. Blacks were more likely to get admitted to the hospital and to receive mechanical ventilation, but less likely to die in the hospital than whites. COVID-19 was first reported as an outbreak of pneumonia of unknown cause in Wuhan, China in December 2019. 1 The virus responsible was subsequently named SARS-CoV-2. The first confirmed case in the USA was reported on 31 January 2020, and the first case in Michigan was reported on 10 March 2020. 2 As of 1 June 2020, 57 532 cases have
Competing interests None declared. Patient consent for publication Not required. Ethics approval The study was approved by Beaumont IRB (study ID: 2020-161). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data available per reasonable request. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http:// creativecommons. org/ licenses/ by-nc/ 4. 0/. ..
Cummings, Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study, Lancet
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Late treatment
is less effective
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