Clinical course and outcome of COVID-19 acute respiratory distress syndrome: data from a national repository
Solh et al.,
Clinical course and outcome of COVID-19 acute respiratory distress syndrome: data from a national repository,
medRxiv, doi:10.1101/2020.10.16.20214130 (Preprint)
Retrospective database analysis of 7,816 Veterans Affairs hospitalized patients showing 47% reduction in progression from ARDS to mortality.
[Gérard, Zhou] show significantly increased risk of acute kidney injury with remdesivir.
This study is excluded in the after exclusion results of meta
analysis:
very late stage, >50% on oxygen/ventilation at baseline; substantial unadjusted
confounding by indication likely.
risk of death, 47.0% lower, HR 0.53, p < 0.001, treatment 63 of 219 (28.8%), control 202 of 424 (47.6%), NNT 5.3, adjusted per study.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Solh et al., 20 Oct 2020, retrospective, database analysis, USA, preprint, 5 authors.
Abstract: medRxiv preprint doi: https://doi.org/10.1101/2020.10.16.20214130; this version posted October 20, 2020. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
CLINICAL COURSE AND OUTCOME OF COVID-19 ACUTE RESPIRATORY DISTRESS SYNDROME:
DATA FROM A NATIONAL REPOSITORY
Ali A. El-Solh, MD, MPH ; Umberto G. Meduri, MD ; Yolanda Lawson, MS ; Michael Carter,
1-3
4
1
PharmD , Kari A. Mergenhagen, PharmD
1
1
1
VA Western New York Healthcare System, Buffalo, NY.; Division of Pulmonary, Critical Care, and
2
Sleep Medicine, Department of Medicine; Department of Epidemiology and Environmental Health,
3
State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of
Public Health and Health Professions; Buffalo, NY; and Memphis VA Medical Center, Memphis,
4
Tennessee
Please address any correspondence and reprint request to:
Ali El Solh, MD, MPH
VA Western New York Healthcare System
3495 Bailey Avenue
Buffalo, NY 14215
Tel (716) 862-7392
Fax (716) 862-6526
Email: solh@buffalo.edu
Summary conflict of interest statements: AES has received grant support from the Department of
Veterans Affairs. UGM has received grant support from the Department of Veterans Affairs. YL
declares no conflict to report. MC declares no conflict to report. KM declares no conflict to report.
Funding information: None
Acknowledgments: The views expressed in this manuscript do not communicate an official position
of the Department of Veterans Affairs.
1
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
medRxiv preprint doi: https://doi.org/10.1101/2020.10.16.20214130; this version posted October 20, 2020. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
ABSTRACT
Background: Mortality attributable to coronavirus disease-19 (COVID-19) 2 infection occurs mainly
through the development of viral pneumonia-induced acute respiratory distress syndrome (ARDS).
Research Question: The objective of the study is to delineate the clinical profile, predictors of
disease progression, and 30-day mortality from ARDS using the Veterans Affairs Corporate Data
Warehouse.
Study Design and Methods: Analysis of a historical cohort of 7,816 hospitalized patients with
confirmed COVID-19 infection between January 1, 2020, and August 1, 2020. Main outcomes were
progression to ARDS and 30-day mortality from ARDS, respectively.
Results: The cohort was comprised predominantly of men (94.5%) with a median age of 69 years
(interquartile range [IQR] 60-74 years). 2,184 (28%) were admitted to the intensive care unit and
643 (29.4%) were diagnosed with ARDS. The median Charlson Index was 3 (IQR 1-5). Independent
predictors of progression to ARDS were body mass index (BMI)≥ 40 kg/m , diabetes, lymphocyte
2
counts<700x109/L, LDH>450 U/L, ferritin >862 ng/ml, C-reactive protein >11 mg/dL, and Ddimer >1.5 ug/ml. In contrast, the use of an anticoagulant lowered the risk of developing ARDS
(OR 0.66 [95% CI 0.49-0.89]. Crude 30-day mortality rate from ARDS was 41% (95% CI 38%-45%).
Risk of death from ARDS was..
Late treatment
is less effective
solh
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