Abstract
Introduction. Even now — a year after the pandemic announcement by WHO, there is lack of clinical evidence to confirm the efficacy of the majority of anti-COVID drugs, evenly for general and critically ill patients. Objective. To estimate the efficacy and safety of some anti-COVID-19 drugs as well as the impact of the demographic data and comorbidity on clinical outcomes of critically ill patients. Materials and methods. The single-center retrospective cohort study was performed on critically ill patients admitted to the ICU of Moscow Municipal Hospital No. 68 from March 6 to June 3, 2020. Anthropometric parameters, severity of the condition and comorbidities, as well as CT data, treatment in the ICU, duration of mechanical ventilation and the patients’ length of staying the ICU were taken into account and analyzed. Results. Overall, 403 patients (231 male, average age: 62.4 ± 15.3 years, range from 21 to 97 years) were enrolled into the study. In hospital mortality rate appeared to be 44.9 % (181/403) and was equal for men and for women (p = 1,000). The application of low molecular weight heparin was the single one significant predictor of mortality reduction according to the results of multivariate analysis — HR = 0.742 (0.545–0.991), p = 0.045. The main unmodifiable predictors for mortality elevation in the ICU were: age 65+ (RR 2.116 [1.680–2.664], p < 0.001) and Charlson’s comorbidity index (HR 1.136 [1.087–1.188], p < 0.001). The group of patients with a fatal outcome had a higher comorbidity index, the number of points on the SOFA scale (p < 0.001), as well as a larger median number of days in the ICU (p = 0.012). Conclusions. Current study has convincingly proved that low molecular weight heparin to be used for while treating severe acute respiratory syndrome coronavirus 2 patients in intensive care settings.
References
- Zhai P., Ding Y., Wu X., et al. The epidemiology, diagnosis and treatment of COVID-19. International Journal of Antimicrobial Agents. 2020; 55(5): 105955. DOI: 10.1016/j.ijantimicag.2020.105955
- Ciceri F., Castagna A., Rovere-Querini P., et al. Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy. Clinical Immunology. 2020; 217: 108509. DOI: 10.1016/j.clim.2020.108509
- Littera R., Campagna M., Deidda S., et al. Human Leukocyte Antigen Complex and Other Immunogenetic and Clinical Factors Influence Susceptibility or Protection to SARS-CoV-2 Infection and Severity of the Disease Course. The Sardinian Experience. Frontiers in Immunology. 2020; 11: 605688. DOI: 10.3389/fimmu.2020.605688
- RECOVERY Collaborative Group, Horby P., Lim W., Emberson J., et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021; 384(8): 693–704. DOI: 10.1056/NEJMoa2021436
- Simonovich V., Burgos Pratx L., Scibona P., et al. A Randomized Trial of Convalescent Plasma in Covid-19 Severe Pneumonia. N Engl J Med. 2021; 384(7): 619–29. DOI: 10.1056/NEJMoa2031304
- Salama C., Han J., Yau L., et al. Tocilizumab in Patients Hospitalized with Covid-19 Pneumonia. N Engl J Med. 2021; 384(1): 20–30. DOI: 10.1056/NEJMoa2030340
- Li G., De Clercq E. Therapeutic options for the 2019 novel coronavirus (2019-nCoV) Nat. Rev. Drug Discov. 2020; 19(3): 149–50. DOI: 10.1038/d41573-020-00016-0
- Fiolet T., Guihur A., Rebeaud M., et al. Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis. Clin Microbiol Infect. 2021; 27(1): 19–27. DOI: 10.1016/j.cmi.2020.08.022
- Yang T., Chou C., Yang Y., et al. Systematic review and meta-analysis of the effectiveness and safety of hydroxychloroquine in treating COVID-19 patients. J Chin Med Assoc. 2021; 84(2): 233–41. DOI: 10.1097/JCMA.0000000000000425
- int [Internet]. Therapeutics and COVID-19: living guideline; c22 [updated 2021 Apr 16; cited 2021 Apr 24]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2021.1
- Zhang S., Li L., Shen A., et al. Rational Use of Tocilizumab in the Treatment of Novel Coronavirus Pneumonia, Shengyu Zhang, Clinical DrugInvestigation. 2020; 40: 511–18. DOI: 10.1007/s40261-020-00917-3
- Zhao M., Lu J., Tang Y., et al. Tocilizumab for treating COVID-19: a systemic review and meta-analysis of retrospective studies. Eur J Clin Pharmacol. 2021; 77(3): 311–19. DOI: 10.1007/s00228-020-03017-5
- Hariyanto T., Hardyson W., Kurniawan A. Efficacy and Safety of Tocilizumab for Coronavirus Disease 2019 (Covid-19) Patients: A Systematic Review and Meta-analysis. Drug Res (Stuttg). 2021; 71(5): 265–74. DOI: 10.1055/a-1336-2371
- НарделлиП., Ландони Д. COVID-19-ассоциированный тромбовоспалительный статус: гипотеза MicroCLOTS и ее перспективы. Общая реаниматология. 2020; 16(3): 14–15. DOI: 10.15360/1813-9779-2020-3-0-2 [Nardelli P., Landoni G. COVID-19-Related Thromboinflammatory Status: MicroCLOTS and Beyond (Editorial). General Reanimatology. 2020; 16(3): 14–15. (In Russ)]
- Tremblay D., van Gerwen M., Alsen M. Impact of anticoagulation prior to COVID-19 infection: a propensity score-matched cohort study [Letter]. Blood. 2020; 136: 144–7. DOI: 10.1182/blood.2020006941
- Fox S., Akmatbekov A., Harbert J. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Med. 2020; 8: 681–6. DOI: 10.1016/S2213-2600(20)30243-5
- Hasan S., Radford S., Kow C., Zaidi S. Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis. Journal of thrombosis and thrombolysis. 2020; 50(4): 814–21. DOI: 10.1007/s11239-020-02235-z
- ru [Internet]. Temporary guidelines [updated 2020 Apr 28; cited 2021 Apr 24]. Available from: https://static-1.rosminzdrav.ru/system/attachments/attaches/000/050/116/original/28042020_MR_COVID-19_v6.pdf
- Li A., Li M., Crowther M., Vazquez S. Drug-drug interactions with direct oral anticoagulants associated with adverse events in the real world: A systematic review. Thromb Res. 2020; 194:240–5. DOI: 10.1016/j.thromres.2020.08.016
- Sampson M., Cao K., Gish P., et al. Dosing Recommendations for Quetiapine When Coadministered With HIV Protease Inhibitors. J Clin Pharmacol. 2019; 59(4): 500–9. DOI: 10.1002/jcph.1345
- Feingold K. Lipid and Lipoprotein Levels in Patients with COVID-19 Infections. South Dartmouth (MA): MDText.com, Inc.; 2020.
- Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Temporary guidelines. Version 6 (28.04.2020).
- Hasan S., Radford S., Kow C. Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis. J Thromb Thrombolysis 50. 2020: 814–21. DOI: 10.1007/s11239-020-02235-z
- Palaiodimos L., Kokkinidis D., Li W., et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020; 108: 154262. DOI: 10.1016/j.metabol.2020
- Rentsch C., Beckman J., Tomlinson L., et al. Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study. BMJ. 2021; 372: n311. DOI: 10.1136/bmj.n311
- Marietta M., Coluccio V., Luppi M. COVID-19, coagulopathy and venous thromboembolism: more questions than answers. Intern Emerg Med. 2020; 15(8): 1375–87. DOI: 10.1007/s11739-020-02432-x
- Muñoz-Rivas N., Abad-Motos A., Mestre-Gómez B., et al. Systemic thrombosis in a large cohort of COVID-19 patients despite thromboprophylaxis: A retrospective study. Thromb Res. 2021; 199: 132–42. DOI: 10.1016/j.thromres.2020.12.024
- Pawlowski C., Venkatakrishnan A., Kirkup C., et al. Enoxaparin is associated with lower rates of mortality than unfractionated Heparin in hospitalized COVID-19 patients. EClinicalMedicine. 2021; 33: 100774. DOI: 10.1016/j.eclinm.2021.100774
- Guaraldi G., Meschiari M., Cozzi-Lepri A., et al. Tocilizumab in patients with severe COVID-19: a retrospective cohort study. Lancet Rheumatol. 2020; 2(8): e474–e484. DOI: 10.1016/S2665-9913(20)30173-9
- RECOVERY Collaborative Group. Lopinavir-ritonavir in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. 2020; 396(10259): 1345–52. DOI: 10.1016/S0140-6736(20)32013-4
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