ABSTRACT
Rationale: The optimal treatment regimen for hospitalized patients with COVID-19 infection remains to be determined. The purpose of this study was to compare how treatment with convalescent plasma (CP) monotherapy, remdesivir (RDV) monotherapy, and combination therapy (CP + RDV) in patients with COVID-19 affected clinical outcomes. Methods: This retrospective observational study was conducted between May-August 2020 at a 150-bed academic community hospital in San Joaquin County, California. Patients with COVID-19 infection who were hospitalized during the study period received CP, RDV, or a combination of both. Clinical outcomes including mortality, discharge disposition, hospital length of stay, ICU length of stay, and total ventilation days were compared between each treatment group and stratified by ABO blood group. An exploratory analysis identified risk factors for mortality. Adverse effects were also evaluated. Results: A total of 213 patients with COVID-19 were admitted and 106 patients received one of the three prespecified treatments during the study period. 53 received CP alone, 11 received RDV alone, and 42 received combination therapy. RDV monotherapy showed an increased chance of survival compared to combination therapy or CP monotherapy (p = 0.052) (Figure 1). There were 15, 3, and 6 deaths in the CP, RDV, and CP + RDV groups, respectively. The median number of ventilation days was the longest in the CP + RDV group (8, IQR 4.5-14, p = 0.091). The median ICU length of stay was also longest in the CP + RDV group (8, IQR 4.5-15.5, p = 0.220). The median hospital length of stay was longest in the CP group (11, IQR 7-15.5, p = 0.175). Age (p = 0.036), initial SOFA score (p = 0.013), and intubation (p = 0.005) were statistically significant predictors of mortality. Patients with type O blood had less ventilation days, ICU LOS, and total LOS but the difference was not statistically significant. Thirteen treatment-related adverse events occurred. Conclusion: No significant differences in clinical outcomes including mortality, length of stay, or total ventilator days were observed between hospitalized patients with COVID 19 treated with RDV, CP, or CP + RDV. Elderly patients, those with a high initial SOFA score, and those who require intubation are at increased risk of mortality associated with COVID-19. Blood type did not demonstrate significant differences in clinical outcomes.
ABSTRACT
Introduction: In December 2019 a new respiratory disease known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) was identified in Wuhan, China. Three months later it was declared a pandemic by WHO. In the United States, the first case was identified on January 19, 2020, and in San Joaquin County, California on March 9, 2020. Since then the case count has surged to over 36,000 in San Joaquin county with more than 500 deaths and community transmission is believed to be widespread. Our aim was to study the patient's initial characteristics, presentation and outcomes at San Joaquin General Hospital providing care to underserved population. Methods: This was a retrospective observational study of patients with SARS-COV-2 infection in 150-bed county hospital between March-October 2020. Confirmed cases of SARS-COV-2 were defined by a positive result on a reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay from a nasopharyngeal swab. Clinical Characteristics of SARS-COV-2 were obtained through review of Electronic Medical Records. Results: Data was obtained from 1168 positive cases with SARS-COV-2 infection. Average age was 42 years, 54% were male, by ethnicity majority were Hispanic (60%), Asians (9%), African American (9%), White (9%) and others (11%). Of the overall positive cases, 28% (n=323) were hospitalized and 9% (n=102) were admitted to ICU. On admission, the most common symptom was cough (57%), followed by fever (50%) and dyspnea (38%). Average of Comorbidities among hospitalized patients was 3, most common was Obesity (36%, n=419), followed by hypertension (24%, n=275), diabetes (20%, n=236) and cardiovascular disease (excluding hypertension) (6%, n=72). Of the 323 hospitalizations, 31.5% patients were admitted to ICU for acute respiratory failure, and 21% patients required invasive mechanical ventilation. Mean ICU length of stay was 9.3 days and mean duration of invasive mechanical ventilation was 10.9 days. Overall mortality was 3% for all positive cases, 16% in hospitalized patients, 33% in ICU admits and was 49% in intubated patients. Conclusion: Major risk factors for SARS-COV-2 include male gender, Hispanic ethnicity, obesity and hypertension. Patients admitted to ICU, especially requiring invasive mechanical ventilation had the worse prognosis.