ABSTRACT
Background. There are few real-world data on the use of remdesivir (RDV) looking at timing of initiation in relation to symptom onset and severity of presenting disease. Methods. We conducted multi-country retrospective study of clinical practice and use of RDV in COVID-19 patients. De-identified medical records data were entered into an e-CRF. Primary endpoints were all-cause mortality at day 28 and hospitalization duration. We assessed time from symptom onset to RDV start and re-admission. We included adults with PCR-confirmed symptomatic COVID-19 who were hospitalized after Aug 31, 2020 and received at least 1 dose of RDV. Descriptive analyses were conducted. Kaplan-Meier methods were used to calculate the mortality rate, LogRank test to compare groups defined by severity of disease. Competing risk regression with discharge and death as competing events was used to estimate duration of hospitalization, and Gray's test to compare the groups. Results. 448 patients in 5 countries (12 sites) were included. Demographics are summarized (table) by 3 disease severity groups at baseline: no supplemental oxygen (NSO), low flow oxygen ≤6 L/min (LFO), and high-flow oxygen > 6L/min (HFO). No demographic differences were found between groups except for the higher percentage of cancer/chemotherapy patients in NSO group. Corticosteroids use was HFO 73.6%, LFO 62.7%, NSO 58.0%. Mortality rate was significantly lower in NSO, and LFO groups compared with HFO (6.2%, 10.2%, 23.6%, respectively;Fig1). Median duration of hospitalization was 9 (95%CI 8-10), 9 (8-9), 13 (10-15) days, respectively (Fig2). Median time from first symptom to RDV start was 7 days in all 3 groups. Patients started RDV on day 1 of hospitalization in HFO and LFO and day 2 on NSO groups. And received a 5 day course (median). Readmission within 28-days of discharge was < 5% and similar across all 3 groups. Conclusion. In this real-world cohort of COVID-19 positive hospitalized patients, RDV use was consistent across countries. RDV was started within a median of 7 days from symptom within 2 days of admission and given for a median of 5 days. Higher mortality rate and duration of hospitalization was seen in the HFO group and similar rates seen in the LFO and NSO groups. Readmission was consistently low across all 3 groups.
ABSTRACT
Une prévalence élevée d'embolie pulmonaire (EP) a été décrit au cours de la COVID-19, avec une morbi-mortalité significative. L'objectif était d'identifier des facteurs prédictifs d'EP chez des patients atteints de COVID-19 sévères hospitalisés hors réanimation. Au cours d'une étude rétrospective multicentrique nationale française, nous avons inclus entre le 6 et le 28 avril 2020, les patients atteints de COVID-19 confirmée par RT-PCR, hospitalisés en service de Médecine Interne ou de Pneumologie, avec un angioscanner thoracique réalisé au Service d'Accueil des Urgences pour suspicion d'EP. Les données de base, les traitements et l'évolution ont été recueillies lors de l'admission et au dernier suivi disponible. Des modèles de régression uni et multivariés ont été utilisés pour identifier les facteurs prédictifs associés au diagnostic d'EP confirmée. Au total, 88 patients (âge médian [interquartile range IQR] de 68 ans [60-78]) ont été analysés. Sur la base de l'angioscanner thoracique, une EP a été confirmée chez 47 (53,4 %) patients, et réfutée chez 41 autres. Un taux de D-dimères ≥ 3000 ng/mL (Odds ratio OR = 8,2 [intervalle de confiance à 95 %] 1,3-74,2, sensibilité (Se) 0,84, spécificité (Sp) 0,78, p = 0,03), un taux de leucocytes ≥ 12 G/L (OR = 29,5 [2,3-1221,2], Se 0,47, Sp 0,92, p = 0,02) et une ferritinémie ≥ 480 μg/L (OR = 17,0 [1,7-553,3], Se 0,96, Sp 0,44, p = 0,03) étaient associés au diagnostic d'EP de manière indépendante. L'association d'un taux de D-dimères ≥ 3000 ng/mL et d'un taux de leucocytes ≥ 12 G/L était très associés au diagnostic d'EP (OR = 21,4 [4,0-397,9], p = 0,004). Le taux de leucocytes, de D-dimères et la ferritinémie sont des biomarqueurs simples et facilement disponibles à l'admission pour prédire le diagnostic d'embolie pulmonaire chez des patients atteints de COVID-19 hospitalisés hors réanimation. Ces biomarqueurs pourraient intégrer la démarche diagnostique d'embolie pulmonaire et à l'initiation rapide d'une anticoagulation curative au cours de la COVID-19, et pourraient inversement réduire le nombre d'angioscanner thoracique non nécessaire. (French) [ABSTRACT FROM AUTHOR] Copyright of Revue de Médecine Interne is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)