Fighting back: optimising treatment for COVID-19最新文献

{"title":"P189 Use of angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers in COVID-19 infection does not adversely affect clinical outcomes including need for non-invasive and invasive ventilation","authors":"A. Amrapala, M. Win, A. Ainley","doi":"10.1136/thorax-2021-btsabstracts.298","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.298","url":null,"abstract":"IntroductionIt has been hypothesized that use of Angiotensin-Converting-Enzyme Inhibitors (ACE-I) and Angiotensin Receptor Blockers (ARB) are associated with worse outcomes in COVID-19 through upregulation of ACE2 receptors.1 Recent studies have shown no association between ACE-I/ARB use and increased mortality but there is limited information on other markers of disease severity such as Continuous Positive Airway Pressure (CPAP) requirement and need for intubation. We assessed the effect of ACE-I/ARB on the outcomes of COVID-19 patients.MethodsA retrospective observational study of patients with suspected or confirmed COVID-19 admitted to the respiratory units during a 1-year period. Patient demographics, clinical and medication history and clinical outcomes were extracted from written and electronic records. Primary outcomes – LOS, CPAP requirement, intensive care (ICU) admission, intubation and death – were compared between those who received ACE-I/ARB concurrently with their COVID-19 treatment and those who did not. Statistical analysis was performed using chi-squared test and odds ratio (OR).ResultsOf 521 patients with suspected or confirmed COVID-19 (median age 59 years, 62.6% male), 183 (35.1%) required CPAP, 108 (20.7%) were admitted to ICU, 60 (11.5%) were intubated and 41 (7.9%) died. In total, 151 (29%) were on ACE-I/ARB treatment, most commonly for hypertension. There was no difference in median LOS between those on ACE-I/ARB treatment and those not (11 and 10 days respectively, p=0.20). There was no difference between CPAP requirement (OR 1.13, 95% CI 0.71–1.56), admission to intensive care (OR 0.64, 95% CI 0.50–1.36), intubation (OR 0.65, 95% CI 0.43–1.58) and death (OR 1.15, 95% CI 0.53–2.11) between the two groups (p>0.05).ConclusionThere was no difference in clinical outcomes between COVID-19 patients on ACE-I/ARB and those who were not, in particular with regards to need for non-invasive and invasive ventilation. Our findings support current recommendations for continued use of ACE-I/ARB in COVID-19 infection.ReferenceFang L, et al. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? The Lancet. Respiratory medicine 2020;8(4):e21. doi:10.1016/S2213-2600(20)30116-8","PeriodicalId":143926,"journal":{"name":"Fighting back: optimising treatment for COVID-19","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128853572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P190 The impact of drug therapies on COVID-19 mortality in a UK tertiary centre","authors":"T. Kurmoo, M. Mayisha Ahmad, R. Wang, N. Chaudhuri","doi":"10.1136/thorax-2021-btsabstracts.299","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.299","url":null,"abstract":"Introduction and ObjectivesThe availability of treatment options for Covid-19 is rapidly expanding. Whilst the efficacy data is well-established from clinical trials, real-life efficacy of drug therapies remains lacking. We aimed to compare clinical outcomes between first and second wave of Covid-19 and determine real-world effectiveness of dexamethasone on 30-day mortality.MethodsThis is a retrospective observational study. Clinical data and information regarding 30-day mortality, length of stay (LOS) and Intensive Care Unit (ICU) admission of hospitalised Covid-19 patients during early first wave (10.03.2020 to 13.04.2020) and second wave (01.12.2020 to 09.02.2021) were collected. Treatment was limited to second wave and included either dexamethasone only or both remdesivir and dexamethasone. The effectiveness of dexamethasone only on 30-day mortality was measured.ResultsOf 373 patients (64.3% male) during the first wave, 24.9% died within 30 days. The 30-day mortality rate was lower during the second wave (61/324, 18.8%, p-value= 0.064). Patients were younger (mean [SD], 60.0 [16.5] years) and had higher body mass index (mean [SD], 30.3 [11.0] kg/m2) during the second wave than the first wave (68.7 [14.8] years and 28.2 [7.70] kg/m2). In the first wave, no patients received specific drug therapy for Covid-19. However, 86.5% of patients received dexamethasone only during the second wave. The LOS for the first wave was longer (median (IQR): 5 (2–11) days) compared to the second wave (4 (2–9) days, p=0.013). ICU admission during the second wave (11.2%) was also lower than the first wave (23.4%, p<0.001). In second wave, 14.3% of patients who were given dexamethasone died within 30 days compared to 25% who had no treatment (p-value=0.088).ConclusionsIn the real-world setting, there was an improvement in mortality, shortened hospital LOS and lower ICU admission rate between early first and second waves of the pandemic. The major difference in treatment strategy between the two waves was the approval of drug therapies in hospitalised patients. Dexamethasone reduced the 30-day mortality, although it did not reach statistical significance, likely due to the retrospective nature and small sample size of this study. Our findings corroborate clinical trial data on the benefit of dexamethasone therapy.","PeriodicalId":143926,"journal":{"name":"Fighting back: optimising treatment for COVID-19","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129801080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P188 Tick tock...where and when can we give toc? Review of COVID-19 patients receiving tocilizumab in a non critical care setting","authors":"K. Aiken, M. Wilson, E. Keelan","doi":"10.1136/thorax-2021-btsabstracts.297","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.297","url":null,"abstract":"IntroductionThe REMAP-CAP trial demonstrated the positive effects of interleukin-6 receptor antagonists (tocilizumab and sarilumab), on mortality in COVID-19 patients managed in a critical care setting.1 Prior to this, adjuvant drug therapies such as remdesivir and dexamethasone have shown limited benefits regarding COVID-19 related mortality in patients requiring non-invasive respiratory, managed in non-critical care settings.During the pandemic the Mater Hospital, Belfast was designed as the local COVID-19 centre. Prior to January 2021 standard ward level care included IV antibiotics, IV remdesivir, oral dexamethasone and non-invasive ventilation. Continuous positive airway pressure was used first line (commenced when FiO2 requirements exceeded 4L/min via nasal cannula). After the release of the Department of Health’s position statement regarding tocilizumab for COVID-19 patients on respiratory support, a decision was taken to use tocilizumab off license in a non-critical care setting.Our hypothesis was that COVID-19 positive patients on non-invasive ventilation who received tocilizumab in addition to standard care would have reduced hospital mortality compared with standard care alone. The REMAP-CAP trial administered tocilizumab to COVID-19 patients in a critical care setting, however we postulated that those ‘less unwell’ patients requiring ward level respiratory support but not ‘critical care’ could still benefit.MethodsPatients commenced on tocilizumab in a non-critical care setting were identified and followed up prospectively. A control group receiving ward level standard care was established retrospectively.ResultsForty patients were recruited into both the control and treatment groups. Results were analysed using Chi-squared statistics on Microsoft Excel. The primary outcome, namely;hospital mortality, demonstrated a significant difference between the groups (p=0.048) with no discernible difference in side effect profile.ConclusionThis data supports the use of tocilizumab in patients with COVID-19 disease, noting its positive effect on hospital mortality for COVID-19 patients on non-invasive respiratory support but not requiring critical care. Moreover, the limited side effect profile witnessed suggests tocilizumab can be safely administered in a non-critical care setting.ReferenceGordon AC, Mouncey PR, Al-Beidh F, Rowan KM, Nichol AD, Arabi YM, et al. Interleukin-6 receptor antagonists in critically ill patients with COVID-19–preliminary report. medRxiv. 2021.","PeriodicalId":143926,"journal":{"name":"Fighting back: optimising treatment for COVID-19","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115053494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P186 Single centre experience of tocilizumab in COVID 19 pneumonia","authors":"Y. Maung Maung Myint, R. Goodka, M. Mehta, S. Ananth, H. Ghani, R. Vancheeswaran","doi":"10.1136/thorax-2021-btsabstracts.295","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.295","url":null,"abstract":"P186 Table 1Clinical parameters of the COVID 19 pneumonia patients who received tocilizumab between January and February 2021Dexamethasone (Control group) Dexamethasone+ Tocilizumab p value Total 38 47 Age Median [IQR] 61.5 54 SF ratio Median [IQR] 106.67 106.67 Gender Male 21 36 Female 17 11 Ethnicity British/White 25 30 Any other white background 1 8 Asian 5 11 Others 8 6 Outcome Death 17 8 0.008 Need for NIV/HFNO 9 27 0.002 ITU admission 12 22 0.18 Need for intubation 4 13 0.06 Length of Hospital Stay Median [IQR] 6 12 <0.001 ConclusionThis study showed that tocilizumab may be associated with mortality benefit but no reduction in the rate of progression to intubation or need of NIV/HFNO. Further data with larger patient cohort is required to ascertain the benefits of tocilizumab in COVID 19 pneumonia.","PeriodicalId":143926,"journal":{"name":"Fighting back: optimising treatment for COVID-19","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115178047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P184 Is continuous positive airway pressure (CPAP) effective in the management of COVID-19 in patients aged 75 and over? A retrospective observational study of a respiratory COVID-19 CPAP unit through its second wave","authors":"H. Alexander, R. McGow, S. Makwana, S. Al-Hakeem, A. Adeyeye, A. Ashish","doi":"10.1136/thorax-2021-btsabstracts.293","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.293","url":null,"abstract":"IntroductionThere remains significant variation in treatment of COVID-19 associated respiratory failure. Although Continuous Positive Airway Pressure (CPAP) has shown to improve outcome in single centre studies, inclusion criteria for commencement of CPAP varies significantly (Ashish et al., 2020;Nightingale et al., 2020). This respiratory-led ward-level dedicated CPAP unit provided CPAP to COVID-19 patients through the ‘second wave’. This study aims to evaluate the efficacy and appropriateness of CPAP for COVID-19 management in an elderly population.MethodsThis retrospective observational study included all patients aged 75 and over who received CPAP for COVID-19 infection, admitted to a district general hospital between 1 October 2020 and 16 February 2021. Fifty-seven patients were included. Data were collected from computerised clinical notes for analysis.ResultsOf 57 patients (39 male and mean age 80), 47 (82.5%) patients died during admission or within 5 days of discharge. 10 (17.5%) patients survived to discharge. Non-survivors had a median CFS of 4;IQR 3–5, as did survivors (median CFS 4;IQR 3–4). Non-survivors had a median of 3 (IQR 2–4) significant comorbidities, and survivors had 2.5 (IQR 2–3.8). Median P/F (PaO2/FiO2) ratio prior to commencing CPAP was 10.5 (IQR 8.4–12.6) for non-survivors and 14.4 (IQR 12.9–18.8) for survivors. The odds of death were 6.8 (p value <0.01) in those with a severe P/F ratio (<13.3).ConclusionThis evidence indicates that CPAP used in patients aged 75 and over, particularly those with a severe P/F ratio prior to commencing CPAP, does not improve mortality. These findings can inform future decision-making and CPAP protocol development to potentially limit its use in this group. Further study of less invasive alternative management options, such as nasal high flow oxygen, is recommended.","PeriodicalId":143926,"journal":{"name":"Fighting back: optimising treatment for COVID-19","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125039527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P187 Clinical outcomes and treatment-related adverse events to tocilizumab in SARS-CoV-2 illness","authors":"S. Ahmad, E. Jenkinson, R. Carney, T. Nahu, J. Quinn, A. Dwarakanath","doi":"10.1136/thorax-2021-btsabstracts.296","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.296","url":null,"abstract":"P187 Figure 1Showing the post Tocilizumab alert card[Figure omitted. See PDF]ConclusionAppropriate treatment protocol and regular monitoring are needed for patients who receive Tocilizumab in severe SARS-CoV-2 illness. Clinicians should bear in mind the high incidence of treatment-related adverse events and the lack of data about long term effects. Treatment alert cards and specific discharge advice may be beneficial.","PeriodicalId":143926,"journal":{"name":"Fighting back: optimising treatment for COVID-19","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120865799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}