Centre of Primary Care and Public Health Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
Carnarvon Medical Centre, Southend-on-Sea, UK.
Intern Emerg Med. 2020 Nov;15(8):1501-1506. doi: 10.1007/s11739-020-02505-x. Epub 2020 Sep 30.
This study investigates the association between the treatment with hydroxychloroquine and mortality in patients admitted with COVID-19. Routinely recorded, clinical data, up to the 24th of April 2020, from the 2075 patients with COVID-19, admitted in 17 hospitals in Spain between the 1st of March and the 20th of April 2020 were used. The following variables were extracted for this study: age, gender, temperature, and saturation of oxygen on admission, treatment with hydroxychloroquine, azithromycin, heparin, steroids, tocilizumab, a combination of lopinavir with ritonavir, and oseltamivir, together with data on mortality. Multivariable logistic regression models were used to investigate the associations. At the time of collecting the data, 301 patients had died, 1449 had been discharged home from the hospitals, 240 were still admitted, and 85 had been transferred to hospitals not included in the study. Median follow-up time was 8 (IQR 5-12) days. Hydroxychloroquine had been used in 1857 patients. Hydroxychloroquine was associated with lower mortality when the model was adjusted for age and gender, with OR (95% CI): 0.44 (0.29-0.67). This association remained significant when saturation of oxygen < 90% and temperature > 37 °C were added to de model with OR 0.45 (0.30-0.68) p < 0.001, and also when all the other drugs, and time of admission, were included as covariates. The association between hydroxychloroquine and lower mortality observed in this study can be acknowledged by clinicians in hospitals and in the community. Randomized-controlled trials to assess the causal effects of hydroxychloroquine in different therapeutic regimes are required.
这项研究调查了羟氯喹治疗与 COVID-19 住院患者死亡率之间的关系。使用了 2020 年 3 月 1 日至 4 月 20 日期间在西班牙 17 家医院住院的 2075 名 COVID-19 患者的常规记录临床数据，截至 2020 年 4 月 24 日。本研究提取了以下变量：年龄、性别、入院时的体温和血氧饱和度、羟氯喹、阿奇霉素、肝素、类固醇、托珠单抗、洛匹那韦与利托那韦联合、奥司他韦的治疗情况，以及死亡率数据。采用多变量逻辑回归模型来研究相关性。在收集数据时，已有 301 名患者死亡，1449 名患者从医院出院回家，240 名患者仍在住院，85 名患者转至未纳入研究的医院。中位随访时间为 8（IQR 5-12）天。1857 名患者使用了羟氯喹。调整年龄和性别后，羟氯喹与较低的死亡率相关，OR（95%CI）为 0.44（0.29-0.67）。当将血氧饱和度<90%和体温>37°C 添加到模型中时，该相关性仍然显著，OR 为 0.45（0.30-0.68），p<0.001，当将所有其他药物和入院时间作为协变量纳入模型时，该相关性仍然显著。本研究中观察到的羟氯喹与较低死亡率之间的关联，可以得到医院和社区临床医生的认可。需要进行随机对照试验来评估不同治疗方案中羟氯喹的因果效应。
