ABSTRACT
It is proven that the blood concentration of antioxidants can impress the severity of viral infections, including COVID-19. However, the lack of a comprehensive study accumulating existing data regarding COVID-19 can be perceived. Therefore, this systematic review is aimed to report the association between the blood concentration of several antioxidants and the overall health condition of COVID-19 patients. We summarized the available data surrounding the serum antioxidant level in COVID-19 patients and COVID-19 outcomes. A systematic search was performed in PubMed, Scopus, Web of Science, and Cochrane, and studies that evaluated the association between antioxidants and COVID-19 outcomes were included. Of 4101 articles that were viewed in the database search, 38 articles were included after the title, abstract, and full-text review. Twenty-nine studies indicated that lower serum antioxidants are associated with worse outcomes, and one study reported no association between serum zinc (Zn) level and COVID-19 outcomes. In most cases, antioxidant deficiency was associated with high inflammatory factors, high mortality, acute kidney injury, thrombosis, intensive care unit (ICU) admission, acute respiratory distress syndrome, cardiac injury, and the need for mechanical ventilation (MV), and there was no significant association between serum antioxidants level and ICU or hospital length of stay (LOS). It seems that higher levels of antioxidants in COVID-19 patients may be beneficial to prevent disease progression. However, clinical trials are needed to confirm this conclusion.
ABSTRACT
INTRODUCTION: Since the late COVID-19, many countries have faced various surges and peaks within the number of infected. Iran was one of the countries that faced many surges and peaks within these years and faced many inadequacies and shortages of resources and hospital beds. Hence the healthcare system started using in-hospital medication such as Remdesivir in outpatients to reduce the load of patients admitted to the hospital. This study aimed to evaluate and compare the reported signs, symptoms, and outcomes of COVID-infected hospitalized and out-patients receiving Remdesivir. METHODS: In this retrospective cohort study, 214 patients (121 outpatient and 93 hospitalized) with moderate levels of Covid infection between October 2021 and February 2022 were studied. Both groups were treated with 200mg of Remdesivir, followed by 100 mg daily intravenous injections for five days; signs and symptoms, such as pain, shortness of breath, cough, fever and etc., of patients at the initiation and the end of treatment were recorded. Moreover, the patients' blood oxygen saturation was assessed two to three times a day, and the mean of the recorded measures was considered as the daily oxygen saturation. The outpatient group had to visit the hospital daily for treatment and assessment. At the treatment's end, mortality rates, disease signs, and symptoms alleviations were compared between the groups. RESULTS: The outpatient and hospitalized group's mean age was 40.30 ± 12.25 and 37.70 ± 12.00 years, and 51.2% and 55.9% were males, respectively. There was no statistical difference between baseline and clinical characteristics in the outpatients and hospitalized groups. After adjusting for oxygen saturation at baseline and gender in the multivariable Cox regression analysis, the risk of death did not statistically differ between the hospitalized and outpatient group (hazard ratio: 0.99, 95% confidence interval: 0.39-2.50)) at the end of the study. CONCLUSION: Based on the results of this study, the outcome, signs, and symptoms of inpatient and outpatient Remdesivir treatment groups did not differ significantly. Hence in COVID-19 surges where we have limitations in admitting patients, outpatient Remdesivir treatment for those without any underlying diseases can be a proper management method.