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0 0.5 1 1.5 2+ Mortality -45% Improvement Relative Risk Remdesivir  Muntean et al.  LATE TREATMENT Is late treatment with remdesivir beneficial for COVID-19? Retrospective 551 patients in Romania Higher mortality with remdesivir (p=0.028) Muntean et al., Pharmaceuticals, December 2023 Favors remdesivir Favors control

Effects of COVID-19 on the Liver and Mortality in Patients with SARS-CoV-2 Pneumonia Caused by Delta and Non-Delta Variants: An Analysis in a Single Centre

Muntean et al., Pharmaceuticals, doi:10.3390/ph17010003
Dec 2023  
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Retrospective 551 severe/critical COVID-19 patients showing higher mortality and higher risk of drug induced liver injury with remdesivir. Authors appear to have reversed the OR for remdesivir - use was more common in non-survivors (61% vs. 50%). Authors report 116 patients treated with HCQ but provide no results for HCQ.
Gérard, Wu, Zhou show significantly increased risk of acute kidney injury with remdesivir.
risk of death, 45.1% higher, RR 1.45, p = 0.03, treatment 71 of 287 (24.7%), control 45 of 264 (17.0%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Muntean et al., 19 Dec 2023, retrospective, Romania, peer-reviewed, 8 authors. Contact: (corresponding author),,,,,,,
This PaperRemdesivirAll
Effects of COVID-19 on the Liver and Mortality in Patients with SARS-CoV-2 Pneumonia Caused by Delta and Non-Delta Variants: An Analysis in a Single Centre
Monica Muntean, Violeta Briciu, Mihaela Lupse, Doina Colcear, Raul Vlad Macicasan, Agnes Csiszer, Alexandra Manole, Amanda Radulescu
Pharmaceuticals, doi:10.3390/ph17010003
The aim of this study was to ascertain patient characteristics, outcomes, and liver injuries in patients infected with different SARS-CoV-2 variants. Data from consecutive adult patients with severe/critical COVID-19 admitted to our hospital during the peak month of the Delta wave were compared to the ancestral, Alpha, and Omicron waves. The dataset of 551 hospitalized patients was similar in the Delta/non-Delta waves. At admission and discharge, the median aminotransferase levels were normal or slightly increased. During the Delta wave (172 vs. 379 non-Delta patients), more patients died (OR 1.69, 95%CI 1.09-2.56) or had liver injury at discharge (alanine aminotransferase, ALT ≥ 2 ULN) (OR 1.97, 95%CI 1.08-3.54). In-hospital mortality was associated with age, lung injury, intensive care unit admission, number of and cardiovascular comorbidities, diabetes, chronic kidney disease, and all inflammatory biomarkers. Serious liver injury at admission (ALT ≥ 5 × ULN) was significantly associated with in-hospital mortality (OR = 7.9, 95%CI 2-28.9). At discharge, drug-induced liver injury (DILI) was found in patients treated with remdesivir, ALT ≥ 2 ULN (OR = 2.62, 95%CI 1.22-5.75). Treatment with dexamethasone, remdesivir, and immunomodulators showed improved survival, OR = 0.50 (95%CI 0.33-0.77). Regardless of the variant and treatment options, less than 2% of patients displayed serious liver injury, which was not found to be a death predictor in multivariable analysis.
Conflicts of Interest: The authors declare no conflict of interest.
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Late treatment
is less effective
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