阿兹夫定对中国新疆 COVID-19 住院患者严重后果的疗效:一项单中心、回顾性、匹配队列研究。

IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES
Abiden Kapar, Songsong Xie, Zihao Guo, Yan Nan, Yaling Du, Xi Yin, Tao Gong, Xiu Gu, Yang Zhou, Wenli Lu, Aimin Yang, Zhaohui Luo, Jianghong Dai, Kailu Wang, Shi Zhao, Kai Wang
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引用次数: 0

摘要

背景:自2022年底以来,阿兹夫定在中国被广泛用于治疗2019年新型冠状病毒病(COVID-19)住院患者。然而,阿兹夫定对严重急性呼吸系统综合征冠状病毒2(SARS-CoV-2)Omicron变异株感染者的严重后果和COVID-19后症状(PCC)的临床疗效数据有限。本研究评估了在SARS-CoV-2 Omicron BA.5占主导地位期间,阿兹夫定对住院COVID-19患者的疗效:从 2022 年 11 月 1 日至 2023 年 7 月 1 日,我们以中国石河子一家三级医院的 COVID-19 住院患者为基础,开展了一项单中心回顾性队列研究,招募实验室确诊的 SARS-CoV-2 感染住院患者。接受阿兹夫定治疗和常规治疗的患者与只接受常规治疗的对照组患者按 1:1 的比例进行倾向得分匹配(PSM),匹配依据包括性别、年龄、种族、原有疾病数量、入院时抗生素使用情况和全血细胞计数等协变量。主要结果是全因死亡和出院后短期(60 天)的 PCC。次要结果包括启动有创机械通气和出院后长期(120 天)的 PCC。采用 Cox 比例危险(PH)回归模型估算全因死亡和有创机械通气的危险比(HR),采用逻辑回归模型估算短期和长期 PCC 的几率比(OR)。根据匹配的协变量进行了分组分析:初步确定了 2,639 名确诊为 COVID-19 的住院患者,并按照排除标准筛选出 2,069 名患者。经过匹配后,297 名阿兹夫定接受者和 297 名匹配对照者符合分析条件。阿兹夫定组的全因死亡发生率低于对照组(0.007/人,95% 置信区间 [CI]:0.001, 0.024/人):0.001,0.024 vs 0.128,95% CI:0.092,0.171),使用阿兹夫定可显著降低死亡风险,使用阿兹夫定可降低死亡风险(HR:0.049,95% CI:0.012,0.205)。亚组分析表明,阿兹夫定对男性、65 岁以上、无既往症和入院时使用抗生素的患者的全因死亡风险有显著疗效。在侵入性机械通气、短期和长期PCC方面,阿兹夫定组与对照组之间未观察到统计学差异:本研究结果表明,在真实世界环境中,接受阿兹夫定治疗与奥米克龙 BA.5 感染住院患者的全因死亡风险较低有关。目前急需开展进一步研究,以验证阿兹夫定对 PCC 的有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effectiveness of azvudine against severe outcomes among hospitalized COVID-19 patients in Xinjiang, China: a single-center, retrospective, matched cohort study.

Background: Since the end of 2022, Azvudine was widely used to treat hospitalized coronavirus disease 2019 (COVID-19) patients in China. However, data on the real-world effectiveness of Azvudine against severe outcomes and post-COVID-19-conditions (PCC) among patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants was limited. This study evaluates the effectiveness of Azvudine in hospitalized COVID-19 patients during a SARS-CoV-2 Omicron BA.5 dominance period.

Methods: From 1 November 2022 to 1 July 2023, an SARS-CoV-2 Omicron BA.5 dominant period, we conducted a single-center retrospective cohort study based on hospitalized patients with laboratory-confirmed SARS-CoV-2 infection from a tertiary hospital in Shihezi, China. Patients treated with Azvudine and usual care were propensity-score matched (PSM) at a 1:1 ratio to a control group in which patients received usual care only, with matching based on covariates such as sex, age, ethnicity, number of preexisting conditions, antibiotic use at admission, and baseline complete blood cell count. The primary outcomes were all-cause death and short-term (60 days) PCC post discharge. The secondary outcomes included the initiation of invasive mechanical ventilation and PCC at long-term post discharge (120 days). Cox proportional hazards (PH) regression models were employed to estimate the hazard ratios (HR) of Azvudine treatment for both all-cause death and invasive mechanical ventilation, and logistic regression models were used to estimate the odds ratios (OR) for short-term and long-term PCC. Subgroup analyses were performed based on a part of the matched covariates.

Results: A total of 2,639 hospitalized patients with SARS-CoV-2 infection were initially identified, and 2,069 ineligible subjects were excluded from analyses. After matching, 297 Azvudine recipients and 297 matched controls were eligible for analyses. The incidence rate of all-cause death was relatively lower in the Azvudine group than in control group (0.007 per person, 95% confidence interval [CI]: 0.001, 0.024 vs 0.128, 95% CI: 0.092, 0.171), and the use of Azvudine was associated with a significantly lower risk of death (HR: 0.049, 95% CI: 0.012, 0.205). Subgroup analyses suggested protection of Azvudine against the risks of all-cause death among men, age over 65, patients without the preexisting conditions, and patients with antibiotics dispensed at admission. Statistical differences were not observed between the Azvudine group and the control group for the risks of invasive mechanical ventilation or short and long-term PCC.

Conclusions: Our findings indicated that Azvudine was associated with lower risk of all-cause death among hospitalized patients with Omicron BA.5 infection in a real-world setting. Further investigation is needed to explore the effectiveness of Azvudine against the PCC after discharge.

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来源期刊
CiteScore
11.20
自引率
0.00%
发文量
66
审稿时长
4-8 weeks
期刊介绍: Expert Review of Anti-Infective Therapy (ISSN 1478-7210) provides expert reviews on therapeutics and diagnostics in the treatment of infectious disease. Coverage includes antibiotics, drug resistance, drug therapy, infectious disease medicine, antibacterial, antimicrobial, antifungal and antiviral approaches, and diagnostic tests.
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