Sandhu Tegveer, Tieng Arlene, Chilimuri Sridhar, Franchin Giovanni
Department of Internal Medicine, BronxCare Health System, Bronx, NY 10457, USA.
Can J Infect Dis Med Microbiol. 2020 Oct 27;2020:8865954. doi: 10.1155/2020/8865954. eCollection 2020.
Colchicine has been used in conditions such as periodic febrile illness, acute pericarditis, and gouty arthritis, all having a common hyperinflammatory response as seen in moderate to severe forms of coronavirus disease 2019 (COVID-19). This project was carried out during the rapid surge of cases in New York City, and the goal was to assess the efficacy of colchicine in treating patients with COVID-19.
Patients admitted to two distinct pulmonary oriented floors of the BronxCare Hospital Center were compared. Patients on one floor were given colchicine in addition to standard of care, while control patients from another floor received only standard of care. Patients who had at least two separate timepoint measurements for at least two out of four serum inflammatory markers (-reactive protein (CRP), -dimer, ferritin, or lactate dehydrogenase (LDH)) were selected for the final comprehensive analysis.
An initial analysis performed on all patients, irrespective of the availability of two timepoint inflammatory markers, revealed a lower mortality (49.1% versus 72.9%, = 0.002), a lower percentage of intubations (52.8% versus 73.6%, = 0.006), and a higher discharge rate (50.9% versus 27.1%, = 0.002), in the patients who received colchicine. Patients in the final comprehensive analysis groups (34 in the colchicine group and 78 in the control group) had a similar prevalence of comorbid medical conditions, except for renal failure, which was higher in the control group (65.3% versus 35.2%, = 0.015). HTN (71.8% versus 52.9%, = 0.053) and DM (51.3% versus 32.4%, = 0.064) were also more prevalent in the control group, although the difference was not statistically significant. Patients who received colchicine had a lower mortality than the control group (47.1% versus 80.8%, = 0.0003), lower rate of intubations (47.1% versus 87.2%, < 0.0001), and a higher discharge rate (52.9% versus 19.2%, = 0.0003). Patients in the colchicine group also showed a more significant decrease in inflammatory markers for -dimer ( = 0.037), CRP ( = 0.014), and ferritin ( = 0.012).
Our study demonstrates that colchicine improved outcomes in patients with COVID-19 receiving standard of care therapy. Future randomized, placebo-controlled clinical trials to assess the potential benefit of colchicine in COVID-19 are warranted.
秋水仙碱已被用于治疗周期性发热疾病、急性心包炎和痛风性关节炎等病症，这些病症都有常见的高炎症反应，在中度至重度新型冠状病毒肺炎（COVID-19）中也可见。本项目在纽约市病例迅速激增期间开展，目的是评估秋水仙碱治疗COVID-19患者的疗效。
对入住布朗克斯护理医院中心两个不同肺病科楼层的患者进行比较。其中一个楼层的患者在接受标准治疗的基础上加用秋水仙碱，而另一个楼层的对照患者仅接受标准治疗。从至少对四种血清炎症标志物（C反应蛋白（CRP）、D-二聚体、铁蛋白或乳酸脱氢酶（LDH））中的两种进行了至少两次单独时间点测量的患者中选取进行最终综合分析。
对所有患者进行的初步分析，无论是否有两个时间点的炎症标志物数据，结果显示接受秋水仙碱治疗的患者死亡率较低（49.1%对72.9%，P = 0.002），插管率较低（52.8%对73.6%，P = 0.006），出院率较高（50.9%对27.1%，P = 0.002）。最终综合分析组的患者（秋水仙碱组34例，对照组78例）除肾衰竭外，合并症的患病率相似，对照组的肾衰竭患病率更高（65.3%对35.2%，P = 0.015）。高血压（71.8%对52.9%，P = 0.053）和糖尿病（51.3%对32.4%，P = 0.064）在对照组中也更常见，尽管差异无统计学意义。接受秋水仙碱治疗的患者死亡率低于对照组（47.1%对80.8%，P = 0.0003），插管率较低（47.1%对87.2%，P < 0.0001），出院率较高（52.9%对19.2%，P = 0.0003）。秋水仙碱组患者的D-二聚体（P = 0.037）、CRP（P = 0.014）和铁蛋白（P = 0.012）炎症标志物下降也更显著。
我们的研究表明，秋水仙碱可改善接受标准治疗的COVID-19患者的预后。有必要开展未来的随机、安慰剂对照临床试验，以评估秋水仙碱在COVID-19中的潜在益处。
