ABSTRACT
Background: Covid-19 pneumonia is the leading cause of death in severe hospitalized patients. Thalidomide has an immunomodulatory and anti-inflammatory effect and thereby decrease lung damage. Methods: This study was a randomized clinical trial that was performed from April 2020 until August 2020 on 60 severe hospitalized Covid-19 pneumonia patients. All patients received the usual care for Covid-19 pneumonia based on our hospital protocols. Patients in the intervention group received thalidomide tablets 100 mg daily for 14 days added to the usual treatment. The primary outcome was the ICU admission rate. Results: Thirty patients were assigned to receive thalidomide and 30 patients usual treatment. Five patients (17.9%) in the thalidomide group required ICU admission and 12 patients (52.2%) in the usual care group (P-value = 0.01). ICU admission hazard ratio was 3.3 higher in the usual care group than the thalidomide group (HR: 3.31 [95% CI: 1.16–9.45]). Hospitalization duration, intubation and mortality showed no significant differences between the two groups (P > 0.05 for all items). No serious and major adverse effects were reported during the trial. Conclusion: The use of thalidomide was associated with a decreased rate of ICU admission in severe hospitalized covid-19 patients.
Subject(s)
COVID-19 , PneumoniaABSTRACT
Background: Already at the time of hospital admission, clinicians require simple tools to identify hospitalized COVID-19 patients at high risk of mortality. Such tools can significantly improve resource allocation and patient management within hospitals. From the statistical point of view, extended time-to-event models are required to account for competing risks (discharge from hospital) and censoring so that active cases can also contribute to the analysis. Methods: We used the hospital-based open Khorshid COVID Cohort (KCC) study with 630 COVID-19 patients from Isfahan, Iran. Competing risk methods are used to develop a death risk chart based on following variables which can simply be measured at hospital admission: gender, age, hypertension, oxygen saturation, and Charlson Comorbidity Index. The area under the receiver operator curve was used to assess accuracy concerning discrimination between patients discharged alive and dead. Results: Cause-specific hazard regression models show that these baseline variables are associated with both hazards, the death as well as the discharge hazard. The risk chart reflects the combined results of the two cause-specific hazard regression models. The proposed risk assessment method had a very good accuracy (AUC=0.872 [CI 95%: 0.835-0.910]). Conclusions: This study aims to improve and validate a personalized mortality risk calculator based on hospitalized COVID-19 patients. The risk assessment of patient mortality provides physicians with additional guidance for making tough decisions.
Subject(s)
COVID-19 , HypertensionABSTRACT
The COVID-19 is rapidly scattering worldwide, and the number of cases in the Eastern Mediterranean Region is rising, there is a need for immediate targeted actions. We designed a longitudinal study in a hot outbreak zone to analyze the serial findings between infected patients for detecting temporal changes from February 2020. In a hospital-based open-cohort study, patients are followed from admission until one year from their discharge (the 1st, 4th, 12th weeks, and the first year). The measurements included demographic, socio-economics, symptoms, health service diagnosis and treatment, contact history, and psychological variables. The signs improvement, death, length of stay in hospital were considered as primary, and impaired pulmonary function and psychotic disorders were considered as main secondary outcomes. Notably, In the last two follow-ups, each patient attends the hospital to complete the Patient Health Questionnaire-9 (PHQ-9) and the Depression Anxiety Stress Scales (DASS-21). Moreover, clinical symptoms and respiratory functions are being determined in such follow-ups. Among the first 600 COVID-19 cases, a total of 490 patients with complete information (39% female; the average age of 57{+/-}15 years) were analyzed. Seven percent of these patients died. The three main leading causes of admission were: fever (77%), dry cough (73%), and fatigue (69%). The most prevalent comorbidities between COVID-19 patients were hypertension (35%), diabetes (28%), and ischemic heart disease (14%). The percentage of primary composite endpoints (PCEP), defined as death, the use of mechanical ventilation, or admission to an intensive care unit was 18%. The following comorbidities were significantly different in the positive and negative PCEP groups: acute kidney disease (p=0.008) and diabetes (p=0.026). For signs and symptoms, fatigue (p=0.020) and sore throat (p=0.001) were significantly different. This long-term prospective Cohort may support healthcare professionals in the management of resources following this pandemic.