ABSTRACT
Purpose: The purpose of this study was to evaluate the effectiveness of either hydroxychloroquine, triple combination therapy (TCT), favipiravir, dexamethasone, remdesivir, or COVID-19 convalescent plasma (CCP) in comparison with standard-of-care for hospitalized patients with COVID-19 using real-world data from Saudi Arabia. Patients and methods: A secondary database analysis was conducted using the Saudi Ministry of Health database for patients with COVID-19. Adult (≥18 years) hospitalized patients with COVID-19 between March 2020 and January 2021 were included in the analysis. A propensity score matching technique was used to establish comparable groups for each therapeutic approach. Lastly, an independent t-test and chi-square test were used to compare the matching groups in the aspects of the duration of hospitalization, length of stay (LOS) in intensive care units (ICU), in-hospital mortality, and composite poor outcome. Multilevel logistic regression model was used to assess the association between the severity stage of COVID-19 and the outcomes while using the medication or intervention used as a grouping variable in the model. Results: The mean duration of hospitalization was significantly longer for patients who received TCT, favipiravir, dexamethasone, or CCP compared to patients who did not receive these therapies, with a mean difference ranging between 2.2 and 4.9 days for dexamethasone and CCP, respectively. Furthermore, the use of favipiravir or CCP was associated with a longer stay in ICU. Remdesivir was the only agent associated with in-hospital mortality benefit. A higher risk of mortality and poorer composite outcome were associated with the use of favipiravir or dexamethasone. However, the logistic regression model reveled that the difference between the two matched cohorts was due to the severity stage not the medication. Additionally, the use of hydroxychloroquine, TCT, or CCP had no impact on the incidence of in-hospital mortality or composite poor outcomes. Conclusion: Remdesivir was the only agent associated with in-hospital mortality benefit. The observed worsened treatment outcomes associated with the use of dexamethasone or FPV shall be attributed to the severity stage rather than the medication use. In light of these varied results, additional studies are needed to continue evaluating the actual benefits of these therapies.
ABSTRACT
The outbreak and continuing impact of COVID-19 have significantly increased the rates of hospitalization and admissions to intensive care units (ICU). This study evaluates clinical outcomes in critically ill patients and investigates variables tied to poor prognosis. A secondary database analysis was conducted to investigate the predictors of poor outcome among critically ill COVID-19 patients in Saudi Arabia. Multivariable logistic regression analysis was used to assess the association between various demographic characteristics, comorbidities, and COVID-19 symptoms and patients' poor prognosis, as a composite outcome. A total of 2257 critically ill patients were identified (male (71.8%), and elderly (37.3%)). The mortality rate was 50.0%, and the composite poor outcome was 68.4%. The predictors of poor outcome were being elderly (OR = 4.79, 95%CI 3.19-7.18), obesity (OR = 1.43, 95%CI 1.1-1.87), having a severe or critical case at admission (OR = 6.46, 95%CI 2.34-17.8; OR = 22.3, 95%CI 11.0-45, respectively), and some signs and symptoms of COVID-19 such as shortness of breath, feeling fatigued or headache, respiratory rate ≥ 30/min, PaO2/FiO2 ratio < 300, and altered consciousness. In conclusion, identifying high-risk populations that are expected to have a poor prognosis based on their criteria upon admission helps policymakers and practitioners better triage patients when faced with limited healthcare resources.
ABSTRACT
Purpose: Venous thromboembolism (VTE), a major complication that has been reported in patients with COVID-19, is associated with an increased risk of mortality. The purpose of this study was to compare in-hospital mortality among hospitalized patients with COVID-19 who received high-intensity versus standard-intensity thromboprophylactic anticoagulation. Patients and Methods: A secondary database analysis was conducted using data for adult patients who were hospitalized for COVID-19 in Saudi Arabia and received enoxaparin for thromboprophylaxis during their hospitalization. While enoxaparin 40 mg daily is considered the standard-intensity, doses higher than the standard but not to reach the therapeutic dose were considered as high-intensity. The primary outcome in the study was in-hospital mortality, and the secondary outcomes included intensive care unit (ICU) and hospital length of stay. Chi-square and t-tests were used to assess the difference between the two independent groups, and propensity score matching was performed to adjust for baseline characteristics. Results: From 3508 patients who received high- or standard-intensity enoxaparin, 1422 patients, 711 in each group, were included in the analyses after propensity score matching. The mean age of the participants was 57.2 years, and around 30% of them were female. About 72% of the patients were admitted to the ICU. No difference was observed between the two groups in the in-hospital mortality outcome (36% vs 33.5% in the high-intensity and the standard group, respectively; RR=1.06, 95% CI 0.95-1.18). However, patients who received high-intensity thromboprophylaxis had a significantly longer duration of hospitalization (15.6 days vs 13.6 days; p=0.003) and ICU stay (12.3 days vs 10.8 days; p=0.039) compared to patients who received the standard dose. Conclusion: The use of high-intensity thromboprophylaxis was not associated with a reduction in mortality. Therefore, our results do not support the routine use of high-intensity prophylactic anticoagulation in both ICU and non-ICU patients with COVID-19.