Composite interventions on outcomes of severely and critically ill patients with COVID-19 in Shanghai, China
Jiasheng Shao, Rong Fan, Chengnan Guo, Xuyuan Huang, Runsheng Guo, Fengdi Zhang, Jianrong Hu, Gang Huang, Liou Cao
doi:10.1101/2023.05.10.23289325
All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
Author contributions
Conflict of Interest All authors in the article declared that they have no competing interests.
Ethical approval Statement This study was approved by the Ethics Committee of Jiading District Central Hospital affiliated to Shanghai University of Medicine and Health Sciences (Approval code 2023K15)
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DOI record:
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"abstract": "<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The sixty-day effects of initial composite interventions for the treatment of severely and critically ill patients with COVID-19 are not fully assessed.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Using a bayesian piecewise exponential model, we analyzed the 60-day mortality, health-related quality of life (HRQoL) and disability in 1082 severely and critically patients with COVID-19 between December 8, 2022 and February 9, 2023 in Shanghai, China. The final 60-day follow-up was completed on April 10, 2023.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 1082 patients (mean age, 78.0 years), 421 [38.9%] women), 139 patients (12.9%) died within 60 days. Azvudine had a 99.8% probability of improving 2-month survival (adjusted HR, 0.44 [95% credible interval, 0.24-0.79]) and Paxlovid had a 91.9% probability of improving 2-month survival (adjusted HR, 0.71 [95% credible interval, 0.44-1.14]) compared with the control. IL-6 receptor antagonist, Baricitinib, and a-thymosin each had a high probability of benefit (99.5%, 99.4%, and 97.5%, respectively) compared to their controls, while the probability of trail-defined statistical futility (HR >0.83) was high for therapeutic anticoagulation (99.8%; HR, 1.64 [95% CrI, 1.06-2.50]), and glucocorticoid (91.4%; HR, 1.20 [95% CrI, 0.71-2.16]). Paxlovid, Azvudine and therapeutic anticoagulation showed significant reduction in disability (p<0.05)</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Among severely and critically ill patients with COVID-19 who received 1 or more therapeutic interventions, treatment with Azvudine had a high probability of improved 60-day mortality compared with the control, indicating its potential in resource-limited scenario. Treatment with IL-6 receptor antagonist, Baricitinib, and a-thymosin also had high probabilities of benefit of improving 2-month survival, among which a-thymosin could improve HRQoL. Treatment with Paxlovid, Azvudine and therapeutic anticoagulation could significantly reduce disability at day 60.</jats:p></jats:sec>",
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