早期服用雷米替韦对住院病人 COVID-19 疾病进展的影响。

IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Wiener Klinische Wochenschrift Pub Date : 2024-08-01 Epub Date: 2024-06-17 DOI:10.1007/s00508-024-02377-7
Moritz Platzer, David Totschnig, Mario Karolyi, Tamara Clodi-Seitz, Christoph Wenisch, Alexander Zoufaly
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引用次数: 0

摘要

背景:抗病毒药物已成为治疗 COVID-19、减少并发症和死亡率的关键。雷米替韦已成为一种有效的治疗药物,适用于有疾病进展风险的住院患者,尤其是在替代治疗不可行的情况下。虽然雷米替韦的推荐治疗时间可延长至症状出现后 7 天,但本研究探讨了尽早服用雷米替韦对临床结果的影响:我们使用连续 PCR 确诊的 SARS-CoV-2 成年患者(≥ 18 岁)的临床数据进行了回顾性分析,这些患者在维也纳 Klinik Favoriten 感染性疾病科住院期间接受了雷米替韦治疗。数据涵盖的时间段为 2021 年 7 月 1 日至 2022 年 4 月 31 日。根据服用雷米替韦的时间将患者分为两组:早期组(症状出现后0-3天)和晚期组(症状出现后≥4天)。主要结果是院内疾病进展,采用世界卫生组织COVID-19临床进展量表进行评估(增加≥1分)。多变量逻辑回归用于评估临床结果,并对年龄、性别、SARS-CoV-2变异体和COVID-19疫苗接种情况进行了调整:共纳入 219 例患者,其中早期组 148 例(67.6%),晚期组 71 例(32.4%)。平均年龄为 66.5 岁(标准差:18.0),68.9% 的患者接种过疫苗,72.6% 的患者感染了奥米克龙病毒变异株。在对混杂因素进行调整后,晚用雷米替韦与需要高流量氧疗(OR 2.52,95% CI 1.40-4.52,p = 0.002)和入住重症监护室(OR 4.34,95% CI 1.38-13.67,p = 0.012)的概率显著增加有关。在晚期组中,临床恶化(OR 2.13,95% CI 0.98-4.64,p = 0.056)和需要任何氧疗(OR 1.85,95% CI 0.94-3.64,p = 0.074)的风险呈上升趋势:结论:与在症状出现后前3天内接受雷米替韦治疗的患者相比,COVID-19住院患者在第3天后接受雷米替韦治疗会增加并发症风险,如需要高流量吸氧治疗和入住ICU。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The effect of early remdesivir administration in COVID-19 disease progression in hospitalised patients.

The effect of early remdesivir administration in COVID-19 disease progression in hospitalised patients.

Background: Antiviral drugs have become crucial in managing COVID-19, reducing complications and mortality. Remdesivir has emerged as an effective therapeutic drug for hospitalized patients at risk of disease progression, especially when alternative treatments are infeasible. While the recommended treatment duration of remdesivir extends up to 7 days post-symptom onset, this study examines how early remdesivir administration impacts clinical outcomes.

Methods: We conducted a retrospective analysis using clinical data from consecutively PCR confirmed SARS-CoV‑2 adult patients (≥ 18 years) who received remdesivir during their hospitalization at the department of infectious diseases, Klinik Favoriten in Vienna. The data covered the period from July 1, 2021, to April 31, 2022. Patients were divided into two groups based on the timing of remdesivir administration: an early group (0-3 days since symptom onset) and a late group (≥ 4 days since symptom onset). The primary outcome was in-hospital disease progression, assessed using the WHO COVID-19 Clinical Progression Scale (≥ 1 point increase). Multivariable logistic regression, adjusted for age, sex, SARS-CoV‑2 variant, and COVID-19 vaccination status, was used to assess clinical outcomes.

Results: In total 219 patients were included of whom 148 (67.6%) were in the early group and 71 (32.4%) were in the late group. The average age was 66.5 (SD: 18.0) years, 68.9% of the patients were vaccinated, and 72.6% had the Omicron virus variant. Late remdesivir administration was associated with a significantly higher probability of needing high-flow oxygen therapy (OR 2.52, 95% CI 1.40-4.52, p = 0.002) and ICU admission (OR 4.34, 95% CI 1.38-13.67, p = 0.012) after adjusting for confounders. In the late group there was a trend towards a higher risk of clinical worsening (OR 2.13, 95% CI 0.98-4.64, p = 0.056) and need for any oxygen therapy (OR 1.85, 95% CI 0.94-3.64, p = 0.074).

Conclusion: Compared to patients who received remdesivir within the first 3 days after symptom onset, administering remdesivir after day 3 in hospitalized COVID-19 patients is associated with higher risk for complications, such as the need for high-flow oxygen therapy and ICU admission.

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来源期刊
Wiener Klinische Wochenschrift
Wiener Klinische Wochenschrift 医学-医学:内科
CiteScore
4.70
自引率
3.80%
发文量
110
审稿时长
4-8 weeks
期刊介绍: The Wiener klinische Wochenschrift - The Central European Journal of Medicine - is an international scientific medical journal covering the entire spectrum of clinical medicine and related areas such as ethics in medicine, public health and the history of medicine. In addition to original articles, the Journal features editorials and leading articles on newly emerging topics, review articles, case reports and a broad range of special articles. Experimental material will be considered for publication if it is directly relevant to clinical medicine. The number of international contributions has been steadily increasing. Consequently, the international reputation of the journal has grown in the past several years. Founded in 1888, the Wiener klinische Wochenschrift - The Central European Journal of Medicine - is certainly one of the most prestigious medical journals in the world and takes pride in having been the first publisher of landmarks in medicine.
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