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Introduction and ObjectivesThe availability of treatment options for Covid-19 is rapidly expanding. Whilst the efficacy data is well-established from clinical trials, real-life efficacy of drug therapies remains lacking. We aimed to compare clinical outcomes between first and second wave of Covid-19 and determine real-world effectiveness of dexamethasone on 30-day mortality.MethodsThis is a retrospective observational study. Clinical data and information regarding 30-day mortality, length of stay (LOS) and Intensive Care Unit (ICU) admission of hospitalised Covid-19 patients during early first wave (10.03.2020 to 13.04.2020) and second wave (01.12.2020 to 09.02.2021) were collected. Treatment was limited to second wave and included either dexamethasone only or both remdesivir and dexamethasone. The effectiveness of dexamethasone only on 30-day mortality was measured.ResultsOf 373 patients (64.3% male) during the first wave, 24.9% died within 30 days. The 30-day mortality rate was lower during the second wave (61/324, 18.8%, p-value= 0.064). Patients were younger (mean [SD], 60.0 [16.5] years) and had higher body mass index (mean [SD], 30.3 [11.0] kg/m2) during the second wave than the first wave (68.7 [14.8] years and 28.2 [7.70] kg/m2). In the first wave, no patients received specific drug therapy for Covid-19. However, 86.5% of patients received dexamethasone only during the second wave. The LOS for the first wave was longer (median (IQR): 5 (2–11) days) compared to the second wave (4 (2–9) days, p=0.013). ICU admission during the second wave (11.2%) was also lower than the first wave (23.4%, p<0.001). In second wave, 14.3% of patients who were given dexamethasone died within 30 days compared to 25% who had no treatment (p-value=0.088).ConclusionsIn the real-world setting, there was an improvement in mortality, shortened hospital LOS and lower ICU admission rate between early first and second waves of the pandemic. The major difference in treatment strategy between the two waves was the approval of drug therapies in hospitalised patients. Dexamethasone reduced the 30-day mortality, although it did not reach statistical significance, likely due to the retrospective nature and small sample size of this study. Our findings corroborate clinical trial data on the benefit of dexamethasone therapy.
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S52 Figure 1Kaplan-Meier curve comparing overall survival in the two treatment groups (conventional oxygen therapy vs continuous positive airway pressure therapy). The null hypothesis of no survival difference is evaluated with a log-rank test (p = 0.92)[Figure omitted. See PDF]DiscussionThis is, as far as we are aware, the first study comparing conventional oxygen therapy with CPAP in cohorts unaffected by physician selection. No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the continued widespread use of CPAP in this patient group.Please refer to page A189 for declarations of interest related to this abstract.
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BACKGROUND: Continuous positive airway pressure (CPAP) therapy is commonly used for respiratory failure due to severe COVID-19 pneumonitis, including in patients deemed not likely to benefit from invasive mechanical ventilation (nIMV). Little evidence exists demonstrating superiority over conventional oxygen therapy, whilst ward-level delivery of CPAP presents practical challenges. We sought to compare clinical outcomes of oxygen therapy versus CPAP therapy in patients with COVID-19 who were nIMV. METHODS: This retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1st March to May 31st, and from 1st September to 31st December. Patients given CPAP were compared to patients receiving oxygen therapy that required FiO2 ≥0.4 for more than 12 hours at hospitals not providing ward-level CPAP. Logistic regression modelling was performed to compare 30-day mortality between treatment groups, accounting for important confounders and within-hospital clustering. FINDINGS: Seven hospitals provided data for 479 patients during the UK COVID-19 pandemic in 2020. Overall 30-day mortality was 75.6% in the oxygen group (186/246 patients) and 77.7% in the CPAP group (181/233 patients). A lack of evidence for a treatment effect persisted in the adjusted model (adjusted odds ratio 0.84 95% CI 0.57-1.23, p=0.37). 49.8% of patients receiving CPAP-therapy (118/237) chose to discontinue it. INTERPRETATION: No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the current treatment guidance and widespread application of CPAP in this setting. FUNDING: L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.
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Introduction The recovery of patients after COVID-19 has been poorly described. Related coronavirus infections (SARSCOV1 and MERS) have protracted recovery time-courses with significant respiratory morbidity,1 suggesting the same may be true for COVID-19. A service evaluation was therefore undertaken to evaluate the short-term effects of COVID-19. Methods Respiratory specialist doctors conducted structured telephone consultations of patients admitted between 17th March 2020 and 2nd May 2020 with a diagnosis of COVID- 19 pneumonia at a teaching hospital. Using time from discharge patients were allocated into 3 groups: 3-4 weeks, 4-5 weeks and 5+. Patients were asked to recall acute COVID-19 symptoms, current symptoms, activity levels, and exercise capacity after discharge. Exercise capacity was quantified by self-assessment of walking distance on flat (metres), stairs (flights). Patient reported outcome measures (MRC dyspnoea scale and WHO performance status) were also collated. Results A total of 102 patients were screened, 70 were included in the study, with the rest being unreachable (n=32) Cough, dyspnoea, fever and lethargy were the most common symptoms at time of admission. All these symptoms, except lethargy, improved following discharge (figure 1). Prevalence in the 5+ week cohort of other symptoms is as follows: dyspnoea 35.7%, cough 11.5%, fever 0%;however, 70% of patients had at least 1 symptom 5 weeks after discharge. Self-reported exercise capacity and MRC dyspnoea score also improved after discharge. Despite this 21.4% of patients had a persistent impairment in walking ability on the flat, 17.8% in stair-climbing with 28.5% persistent deficit in MRC dyspnoea score after 5 weeks. In contrast 40% of patients had a deficit in WHO performance status and this was not affected by time after discharge. In conclusion patients did improve following discharge from hospital for COVID-19 pneumonia, however many were left with residual symptoms and a functional deficit in short term (5 weeks). It remains to be seen whether this results in long term health problems.
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S75 Figure 1Difference between the fibrotic and inflammatory groups in mean 129Xe ADC (a) and LmD (b) at baseline study visit[Figure omitted. See PDF]Conclusions129Xe DW-MRI could have a role in differentiating changes in the airway microstructure between fibrotic and inflammatory ILD. 129Xe RBC:TP has sensitivity to longitudinal change with a decline in gas exchange observed in the fibrotic group but not in the inflammatory group.