COVID-19 therapeutics: What works?

ABSTRACT

INTRODUCTION: SARS-CoV-2 pandemic has brought about a race to determine what is efficacious against this new viral infection that causes COVID-19. We sought to evaluate our therapeutic algorithm for treating patients with SARSCoV- 19. METHODS: Data from patients admitted to our healthcare system with a positive polymerase chain reaction was concurrently reviewed. Demographics, progress during hospitalization, and disposition after discharge from the institutions were entered into an Excel spreadsheet and analyzed by SPSS (ver. 27.0). Continuous variables were analyzed using Student t-test and discrete variables were analyzed using Chi-square or Fisher's exact test. Apriori significance was p ≤ 0.05. Results are presented as percentages or mean (± SD). RESULTS: From March 15, 2020 - July 15, 2020, 127 (29%) of 464 total patients were hospitalized in our healthcare system (CHI Health Nebraska;approximately 1000 hospital beds). A treatment algorithm was developed to determine criteria for COVID-19 therapeutics and shared among the institutions. A total of 66 (14.6%) expired during their hospitalization. Mean age and admission creatinine clearance was significantly different for expired patients (72.2 ± 13.1 vs. 61.6 ± 18.7 years;48.5 ± 33.0 vs. 80.8 ± 50.5 ml/min;p<0.01). Twenty-two percent of patients required an ICU bed. Therapeutics that demonstrated a significant reduction (p<0.01) in mortality included convalescent plasma, proning intubated patients, and dexamethasone. Hydroxychloroquine, azithromycin, and remdesivir use did not reduce mortality. Tocilizumab significantly reduced mortality (13%, p<0.001). CONCLUSIONS: Convalescent plasma, dexamethasone, tocilizumab, and proning intubated patients all positively affected the patient outcome in SARS-CoV-19 infection.