ABSTRACT
BACKGROUND: Hydroxychloroquine combined with azithromycin (HCQ/AZI) has initially been used against coronavirus disease-2019 (COVID-19). In this retrospective study, we assessed the clinical effects of HCQ/AZI, with a 28-days follow-up. METHODS: In a registry-study which included patients hospitalized for COVID-19 between March 15 and April 2, 2020, we compared patients who received HCQ/AZI to those who did not, regarding a composite outcome of mortality and mechanical ventilation with a 28-days follow-up. QT was monitored for patients treated with HCQ/AZI. Were excluded patients in intensive care units, palliative care and ventilated within 24 hours of admission. Three analyses were performed to adjust for selection bias: propensity score matching, multivariable survival, and inverse probability score weighting (IPSW) analyses. RESULTS: Overall, 203 patients were included: 60 patients treated by HCQ/AZI and 143 control patients. During the 28-days follow-up, 32 (16.3%) patients presented the primary outcome and 23 (12.3%) patients died. Propensity-score matching identified 52 unique pairs of patients with similar characteristics. In the matched cohort (n = 104), HCQ/AZI was not associated with the primary composite outcome (log-rank p-value = 0.16). In the overall cohort (n = 203), survival and IPSW analyses also found no benefit from HCQ/AZI. In the HCQ/AZI group, 11 (18.3%) patients prolonged QT interval duration, requiring treatment cessation. CONCLUSIONS: HCQ/AZI combination therapy was not associated with lower in-hospital mortality and mechanical ventilation rate, with a 28-days follow-up. In the HCQ/AZI group, 18.3% of patients presented a prolonged QT interval requiring treatment cessation, however, control group was not monitored for this adverse event, making comparison impossible.
Subject(s)
Azithromycin/therapeutic use , COVID-19 Drug Treatment , Hydroxychloroquine/therapeutic use , SARS-CoV-2/drug effects , Anti-Bacterial Agents/therapeutic use , Antimalarials/therapeutic use , COVID-19/mortality , COVID-19/pathology , COVID-19/virology , Female , Follow-Up Studies , Humans , Intensive Care Units , Male , Middle Aged , Respiration, Artificial , Retrospective Studies , SARS-CoV-2/isolation & purification , Survival Rate , Treatment OutcomeABSTRACT
BACKGROUND: A high prevalence of pulmonary embolism (PE) has been described during COVID-19. Our aim was to identify predictive factors of PE in non-ICU hospitalized COVID-19 patients. METHODS: Data and outcomes were collected upon admission during a French multicenter retrospective study, including patients hospitalized for COVID-19, with a CT pulmonary angiography (CTPA) performed in the emergency department for suspected PE. Predictive factors significantly associated with PE were identified through a multivariate regression model. RESULTS: A total of 88 patients (median [IQR] age of 68 years [60-78]) were analyzed. Based on CTPA, 47 (53.4%) patients were diagnosed with PE, and 41 were not. D-dimer ≥3000 ng/mL (OR 8.2 [95% CI] 1.3-74.2, sensitivity (Se) 0.84, specificity (Sp) 0.78, P = .03), white blood count (WBC) ≥12.0 G/L (29.5 [2.3-1221.2], Se 0.47, Sp 0.92, P = .02), and ferritin ≥480 µg/L (17.0 [1.7-553.3], Se 0.96, Sp 0.44, P = .03) were independently associated with the PE diagnosis. The presence of the double criterion D-dimer ≥3000 ng/mL and WBC ≥12.0 G/L was greatly associated with PE (OR 21.4 [4.0-397.9], P = .004). CONCLUSION: The white blood count, the D-dimer and ferritin levels could be used as an indication for CTPA to confirm PE on admission in non-ICU COVID-19 patients.
Subject(s)
COVID-19/complications , Ferritins/metabolism , Fibrin Fibrinogen Degradation Products/metabolism , Leukocyte Count , Pulmonary Embolism/blood , Pulmonary Embolism/complications , COVID-19/virology , France , Humans , Patient Admission , Retrospective Studies , SARS-CoV-2/isolation & purificationABSTRACT
The incidence of pulmonary embolism (PE) is high during severe Coronavirus Disease 2019 (COVID-19). We aimed to identify predictive and prognostic factors of PE in non-ICU hospitalized COVID-19 patients. In the retrospective multicenter observational CLOTVID cohort, we enrolled patients with confirmed RT-PCR COVID-19 who were hospitalized in a medicine ward and also underwent a CT pulmonary angiography for a PE suspicion. Baseline data, laboratory biomarkers, treatments, and outcomes were collected. Predictive and prognostics factors of PE were identified by using logistic multivariate and by Cox regression models, respectively. A total of 174 patients were enrolled, among whom 86 (median [IQR] age of 66 years [55-77]) had post-admission PE suspicion, with 30/86 (34.9%) PE being confirmed. PE occurrence was independently associated with the lack of long-term anticoagulation or thromboprophylaxis (OR [95%CI], 72.3 [3.6-4384.8]) D-dimers ≥ 2000 ng/mL (26.3 [4.1-537.8]) and neutrophils ≥ 7.0 G/L (5.8 [1.4-29.5]). The presence of these two biomarkers was associated with a higher risk of PE (p = 0.0002) and death or ICU transfer (HR [95%CI], 12.9 [2.5-67.8], p < 0.01). In hospitalized non-ICU severe COVID-19 patients with clinical PE suspicion, the lack of anticoagulation, D-dimers ≥ 2000 ng/mL, neutrophils ≥ 7.0 G/L, and these two biomarkers combined might be useful predictive markers of PE and prognosis, respectively.
Subject(s)
COVID-19/pathology , Fibrin Fibrinogen Degradation Products/metabolism , Neutrophils/pathology , Pulmonary Embolism/virology , Aged , COVID-19/blood , Computed Tomography Angiography , Female , Humans , Logistic Models , Male , Middle Aged , Prognosis , Pulmonary Embolism/blood , Pulmonary Embolism/pathology , Retrospective Studies , Risk Factors , SARS-CoV-2/genetics , Venous Thromboembolism/blood , Venous Thromboembolism/pathology , Venous Thromboembolism/virologyABSTRACT
Introduction L’épidémie de Covid-19 a frappé la France dès février 2020. Selon certains auteurs, près de 40 % des patients hospitalisés présentaient une comorbidité cardiovasculaire [1], dont l’hypertension artérielle, le diabète et la cardiopathie ischémique sont parmi les plus fréquentes. Or ces patients sont souvent traités par des Inhibiteur de l’Enzyme de Conversion ou Antagonistes du Récepteur Angiotensine Aldostérone (IEC/ARA2). Rapidement la communauté médicale a été préoccupée par une éventuelle interaction entre le virus Sars-Cov-2 et le traitement par IEC/ARA2, certains appelant à les arrêter préventivement en cas de contamination [2]. En effet, sur des modèles animaux, le traitement par IEC/ARA 2, augmente l’expression cellulaire membranaire de l’Enzyme de Conversion de l’Angiotensine 2 (ACE2) [3], récepteur auquel le virus SARS cov-2 se lie au niveau de l’épithélium respiratoire. Le traitement par IEC/ARA 2 pourrait donc potentiellement aggraver les manifestations respiratoires du Covid-19 avec un sur-risque de syndrome de détresse respiratoire aiguë et mortalité [2]. L’objectif de notre étude était d’évaluer l’impact du traitement par IEC/ARA2 à l’admission sur la mortalité à 28jours chez les patients hospitalisés pour Covid-19. Matériels et méthodes Il s’agissait d’une étude observationnelle, rétrospective, sur un registre prospectif soumis à accord du Comité de Protection des Personnes (CPP) au sein de l’Hôpital de Montfermeil. Les patients inclus étaient hospitalisés pour Covid-19 entre le 15 mars 2020 et le 2 avril 2020. Le critère de jugement principal était la mortalité à 28jours de l’hospitalisation. Les critères de jugement secondaires étaient l’hospitalisation en soins intensifs, l’intubation orotrachéale à 28jours de l’hospitalisation, l’arrêt du traitement IEC/ARA 2 à l’admission. Le suivi était complet pour 97,3 % des patients. Résultats Deux cents soixante trois patients ont été inclus, l’âge médian était de 59,5 ans avec 41,4 % de patients de sexe féminins, 119 (45,2 %) des patients hospitalisés étaient hypertendus. Parmi les patients inclus, 67 (25,5 %) étaient sous IEC/ARA2 à l’admission et comparés à 196 (74,5 %) qui ne l’étaient pas. Durant le suivi de 28jours, 40 (15,2 %) patients sont décédés. Le traitement par IEC/ARA2 n’impactait pas la mortalité à 28jours (19,7 % vs 13,8 % log rank p=0,54) comme représenté sur la Fig. 1. On ne constatait pas de différence statistiquement significative entre les deux groupes pour l’hospitalisation en soins intensifs (24,2 % vs 18,4 % p=0,30) et l’intubation orotrachéale (15,2 % vs 9,7 % p=0,25) à 28jours de l’admission. Le traitement par IEC ARA2 a été arrêté à l’admission pour 28 (41,8 %) patients. Conclusion Le traitement par IEC/ARA2 n’était pas associé à une augmentation de la mortalité après un suivi de 28jours chez les patients hospitalisés pour Covid-19. Ces données ne sont pas en faveur d’un arrêt systématique des IEC/ARA2 en accord avec les consensus d’experts des sociétés savantes.