ABSTRACT
Objective: To present in-hospital COVID-19 mortality and the associated factors at a public sector tertiary care hospital in Karachi Methodology: The current prospective, observational study was conducted at Jinnah Postgraduate Medical Center, Karachi, Pakistan from June 1 to August 30, 2021 with the approval of the hospital ethics committee. Data was collected prospectively from patients' medical record files. COVID-19 infection positive cases were diagnosed according to the guidelines of the WHO on laboratory investigation of real time polymerase chain reaction tests on a nasopharyngeal or oropharyngeal swab. Result: Total 143 patients were enrolled in the study with median (IQR) age of 58 (48-69). The majority of the patients were males (n=96, 67.13%) and had moderate to severe disease (n=128, 89.51%). During their hospital stay, patients developed the following complications;pneumonia (n=99, 69.23%), ARDS (n=19, 13.28%), sepsis (n=11, 7.69%), septic shock (n=5, 3.49%) and pedal edema (n=2, 1.39%). As many as 104 (72.72%), 69 (48.25%), and 42(29.37%) patients required pharmatherapy, non-invasive ventilation, and mechanical ventilation respectively. While 54 (37.76%) patients died during their hospital stay. On multivariable model, pneumonia, use of non-invasive ventilation, and mechanical ventilation, were identified as independent predictors of mortality. Conclusion: Most of the patients in our study had moderate to severe disease. Therefore, the study indicates that timely presentation to the hospital is of great importance to avoid adverse events which are significantly associated with mortality.
ABSTRACT
Background: Remdesivir is a broad-spectrum antiviral that has been approved as promising medicine worldwide for the fatal pandemic COVID-19 disease. There is a debate over its efficacy, with different studies taking into account a variety of factors. Therefore, we conducted this study to evaluate the primary composite outcome of mortality rate, need for mechanical ventilation, and escalation of care among Remdesivir (RDV) and non-Remdesivir (NoRDV) groups. Methods: Patients with moderate and severe COVID-19, as confirmed by the CPR, were observed retrospectively, before and after including remdsivir in the treatment protocol in the period from August 2020 to February 2021. Result: From the 509 hospitalized patients, 35% received Remdesivir, with 64% being severe patients. The median age in both groups was 59 years old, and there was no significant difference between the two groups regarding gender, baseline characteristics, and comorbidities. In contrast, the median hospital length of stay in the RDV group was lower (8 days) than in the RDV group (8 days) than the NoRDV (9 days), P= 0.004. The composite outcome was 17.7% in the RDV group and 22.2% in the NoRDV group, but the difference was statistically insignificant (p-value 0.289). Adjusted logistic regression demonstrated a non-significant lower association of the composite outcome with RDV use (OR 0.623, 95CI% 0.37-1.02), and a significant reduction occurred in patients <60 years old (OR 0.39, 95%CI 0.17 – 0.83). However, survival analysis for mortality, MV, and transfer to a higher level revealed insignificant differences in the median time between groups. Subgroup analyses showed that RDV utilization had a non-significant effect on the risk of all three outcomes across different groups. Conclusion: Despite controlling all patient characteristics, treatment with RDV did not improve patient outcomes over other antivirals and standard care. There is an urgent need for further studies to investigate and evaluate new therapeutic approaches or combinations.
Subject(s)
COVID-19ABSTRACT
Background: Remdesivir is a broad-spectrum antiviral approved as promising medicine worldwide for deadly pandemic COVID-19 disease. The debate of its efficacy is interesting between different studies with consideration of several factors. We planned this study to evaluate a huge clinical outcome (primary composite outcome) of mortality rate, need for MV, and escalation of care among Remdesivir (RDV) and non-Remdesivir (NoRDV)groups. Methods: : Patients with a PCR - confirmed diagnosis of moderate and severe COVID-19 were observed retrospectively as two comparative groups, before and after including remdesivir in the treatment protocol, from August 2020 to February 2021. Result: From 509 hospitalized patients; 35% received Remdesivir among them 64% were severe patients. Median age, 59 years, was equal in both groups, and there was no significant difference between the two groups regarding gender, baseline characteristics, and co-morbidities. Unlike, the median hospital length of stay was lower among the RDV group (8 days) than the NoRDV (9 days), P= 0.004.The composite outcome occurred in 17.7% in RDV and 22.2% in NoRDV but the difference was statistically insignificant (p-value 0.289). Adjusted logistic regression showed a non-significant lower association of the composite outcome with RDV use (OR 0.623, 95CI% 0.37-1.02), and a significant reduction occurred in patients <60 years old (OR 0.39, 95%CI 0.17 – 0.83). However, survival analysis for mortality, MV, and transfer to a higher level revealed insignificant differences in the median time between groups. Subgroup analyses showed that RDV utilization had a non-significant effect on the risk of all three outcomes across different groups. Conclusion: Despite controlling all patient characteristics, treatment with RDV did not show any improved impact on patient outcomes over other antivirals and standard care. There is a pressing need for further studies to explore and evaluate new therapeutic approaches or combinations.