Real-world effectiveness and factors associated with increased mortality in non-critically ill patients with COVID-19 pneumonia receiving remdesivir.

IF 1.6 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Lucía Quesada Muñoz, Jorge Fernández-Fradejas, Hilario Martinez-Barros, Marina Sánchez Cuervo, Miriam Martín Rufo, Maria Del Rosario Pintor Recuenco, Carmen Quereda Rodríguez-Navarro, Ana María Álvarez-Díaz, Javier Saez de la Fuente
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Abstract

Objectives: Evidence on the effectiveness of remdesivir when used in real-life clinical practice is controversial. This study aims to analyse its effectiveness and the factors associated with increased mortality in non-critically ill patients with COVID-19 pneumonia who require supplemental low-flow oxygen and received remdesivir.

Methods: A retrospective cohort study was conducted at Ramón y Cajal University Hospital (Madrid, Spain) which included all patients treated with remdesivir in our institution during the second pandemic breakout in Spain, from August to November 2020. Treatment with remdesivir was limited to non-critically ill patients with COVID-19 pneumonia requiring low-flow supplemental oxygen, with a treatment duration of 5 days.

Results: A total of 1757 patients were admitted with COVID-19 pneumonia during the study period, of which 281 non-critically ill patients were treated with remdesivir and included in the analysis. Mortality at 28 days after initiation of treatment was 17.1%. The median (IQR) time to recovery was 9 days (6-15). 104 (37.0%) patients had complications during hospitalisation, with renal failure being the most frequent (31 patients; 36.5%). After adjustment for confounding factors, high-flow oxygen therapy was associated with increased 28-day mortality (HR 2.77; 95% CI 1.39 to 5.53; p=0.004) and decreased 28-day clinical improvement (HR 0.54; 95% CI 0.35 to 0.85; p=0.008). A significant difference in survival and clinical improvement was identified between patients treated with high and low-flow oxygen.

Conclusion: The 28-day mortality rate in patients treated with remdesivir needing low-flow oxygen therapy was higher than that published in clinical trials. Age and increased oxygen therapy needed after the beginning of treatment were the main risk factors associated with mortality.

接受雷米替韦治疗的 COVID-19 肺炎非重症患者的实际疗效以及与死亡率增加相关的因素。
目的:在实际临床实践中使用雷米替韦的有效性尚存争议。本研究旨在分析雷米替韦对需要补充低流量氧气并接受雷米替韦治疗的 COVID-19 肺炎非重症患者的疗效以及与死亡率增加相关的因素:拉蒙-伊-卡哈尔大学医院(西班牙马德里)开展了一项回顾性队列研究,纳入了2020年8月至11月西班牙第二次大流行期间本院接受雷米替韦治疗的所有患者。使用雷米替韦治疗的患者仅限于需要低流量补氧的 COVID-19 肺炎非重症患者,治疗时间为 5 天:研究期间共收治了 1757 名 COVID-19 肺炎患者,其中 281 名非重症患者接受了雷米替韦治疗并纳入分析。开始治疗后 28 天的死亡率为 17.1%。康复时间的中位数(IQR)为 9 天(6-15 天)。104例(37.0%)患者在住院期间出现并发症,其中肾功能衰竭最为常见(31例;36.5%)。调整混杂因素后,高流量氧疗与 28 天死亡率增加(HR 2.77;95% CI 1.39 至 5.53;P=0.004)和 28 天临床改善率降低(HR 0.54;95% CI 0.35 至 0.85;P=0.008)有关。结论:接受高流量和低流量氧气治疗的患者在生存率和临床改善方面存在明显差异:结论:接受雷米替韦治疗后需要低流量氧疗的患者的28天死亡率高于临床试验公布的死亡率。年龄和开始治疗后需要更多氧气是与死亡率相关的主要风险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.40
自引率
5.90%
发文量
104
审稿时长
6-12 weeks
期刊介绍: European Journal of Hospital Pharmacy (EJHP) offers a high quality, peer-reviewed platform for the publication of practical and innovative research which aims to strengthen the profile and professional status of hospital pharmacists. EJHP is committed to being the leading journal on all aspects of hospital pharmacy, thereby advancing the science, practice and profession of hospital pharmacy. The journal aims to become a major source for education and inspiration to improve practice and the standard of patient care in hospitals and related institutions worldwide. EJHP is the only official journal of the European Association of Hospital Pharmacists.
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