Rivera-Izquierdo Mario, Valero-Ubierna María Del Carmen, R-delAmo Juan Luis, Fernández-García Miguel Ángel, Martínez-Diz Silvia, Tahery-Mahmoud Arezu, Rodríguez-Camacho Marta, Gámiz-Molina Ana Belén, Barba-Gyengo Nicolás, Gámez-Baeza Pablo, Cabrero-Rodríguez Celia, Guirado-Ruiz Pedro Antonio, Martín-Romero Divina Tatiana, Láinez-Ramos-Bossini Antonio Jesús, Sánchez-Pérez María Rosa, Mancera-Romero José, García-Martín Miguel, Martín-delosReyes Luis Miguel, Martínez-Ruiz Virginia, Jiménez-Mejías Eladio
Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Clínico San Cecilio, Granada, Spain.
Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain.
Med Clin (Engl Ed). 2020 Nov 13;155(9):375-381. doi: 10.1016/j.medcle.2020.06.024. Epub 2020 Oct 9.
In the last months great efforts have been developed to evaluate the more efficient therapeutic agents in the management of patients with COVID-19. Currently, no specific drug combination has consistently demonstrated an association with mortality. The aim of this study was to assess the pattern of associations observed between the different in-hospital treatments administered to a series of 238 patients admitted for COVID-19 and their relationship with mortality.
The electronic medical records of patients that discharged or died from COVID-19 in the Hospital Universitario San Cecilio (Granada, Spain) between March 16 and April 10, 2020 were analysed. From these records, information was obtained on sex, age, comorbidities at admission, clinical information, analytical parameters, imaging tests and empirical treatments used. The outcome variable was the in-hospital mortality. To estimate the associations between the different therapeutic alternatives and the risk of mortality, Hazard Ratios adjusted for age, sex, previous pathologies and severity at discharge were estimated using Cox Regression models.
The most frequently used combination of drugs was low molecular weight heparins, hydroxychloroquine, and ritonavir/lopinavir. None of the analysed treatments showed independent association with mortality. The drugs that showed a greater inverse association with mortality were tocilizumab and corticoids.
The observed association patterns are consistent with previous literature. It seems necessary to design randomized controlled clinical trials that evaluate the possible protector effect of tocilizumab and corticoids in the risk of mortality for some subgroups of COVID-19 hospitalized patients.
在过去几个月里,人们付出了巨大努力来评估治疗新冠肺炎患者更有效的治疗药物。目前,尚无特定药物组合能始终如一地证明与死亡率存在关联。本研究的目的是评估对一系列因新冠肺炎入院的238例患者进行的不同院内治疗之间观察到的关联模式及其与死亡率的关系。
分析了2020年3月16日至4月10日在西班牙格拉纳达圣塞西利奥大学医院出院或死于新冠肺炎的患者的电子病历。从这些记录中,获取了患者的性别、年龄、入院时的合并症、临床信息、分析参数、影像学检查和使用的经验性治疗等信息。结局变量为院内死亡率。为估计不同治疗方案与死亡风险之间的关联,使用Cox回归模型估计了根据年龄、性别、既往病史和出院时严重程度调整后的风险比。
最常用的药物组合是低分子量肝素、羟氯喹和利托那韦/洛匹那韦。所分析的治疗方法均未显示与死亡率有独立关联。与死亡率呈更强负相关的药物是托珠单抗和皮质类固醇。
观察到的关联模式与先前的文献一致。似乎有必要设计随机对照临床试验,以评估托珠单抗和皮质类固醇对某些新冠肺炎住院患者亚组死亡风险的可能保护作用。