Desai Antonio, Caltagirone Giuseppe, Sari Sharon, Pocaterra Daria, Kogan Maria, Azzolini Elena, Savevski Victor, Martinelli-Boneschi Filippo, Voza Antonio
Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy.
Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy.
J Clin Med. 2021 Feb 10;10(4):686. doi: 10.3390/jcm10040686.
Our aim was to investigate the impact of therapeutics with antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on mortality of older adults affected by coronavirus disease 2019 (COVID-19), taking into consideration the time interval from symptoms onset to drugs administration.
Data from 143 COVID-19 patients over 65 years of age admitted to the Humanitas Clinical and Research Center Emergency Department (Milan, Italy) and treated with Lopinavir/ritonavir (LPV/r) or Darunavir/cobicistat (DVR/c) associated to Hydroxychloroquine (HCQ) were retrospectively analyzed. Statistical analysis was performed by using a logistic regression model and survival analysis to assess the role of different predictors of in-hospital mortality, including an early (<6 days from symptoms onset) vs. late treatment onset, signs and symptoms at COVID-19 presentation, type of antiviral treatment (LPV/r or DVR/c) and patients' age (65-80 vs. >80 years old).
Multivariate analysis showed that an older age (OR: 2.54) and dyspnea as presenting symptom (OR: 2.01) were associated with higher mortality rate, whereas cough as presenting symptom (OR: 0.53) and a timely drug administration (OR: 0.44) were associated with lower mortality. Survival analysis demonstrated that the timing of drug administration had an impact on mortality in 65-80 years-old patients ( = 0.02), whereas no difference was seen in those >80 years-old. This impact was more evident in patients with dyspnea as primary symptom of COVID-19, in whom mortality decreased from 57.1% to 38.3% due to timely drug administration (OR: 0.5; = 0.04).
There was a significant association between the use of a combined antiviral regimen and HCQ and lower mortality, when timely-administered, in COVID-19 patients aged 65-80 years. Our findings support timely treatment onset as a key component in the treatment of COVID-19.
我们的目的是研究针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）具有抗病毒活性的疗法对2019冠状病毒病（COVID-19）老年患者死亡率的影响，同时考虑从症状出现到药物给药的时间间隔。
回顾性分析了143例65岁以上因COVID-19入住意大利米兰胡马纳塔临床与研究中心急诊科并接受洛匹那韦/利托那韦（LPV/r）或达芦那韦/考比司他（DVR/c）联合羟氯喹（HCQ）治疗的患者的数据。采用逻辑回归模型和生存分析进行统计分析，以评估不同预测因素对院内死亡率的作用，包括早期（症状出现后<6天）与晚期治疗开始、COVID-19表现时的体征和症状、抗病毒治疗类型（LPV/r或DVR/c）以及患者年龄（65-80岁与>80岁）。
多变量分析显示，高龄（比值比：2.54）和以呼吸困难为表现症状（比值比：2.01）与较高死亡率相关，而以咳嗽为表现症状（比值比：0.53）和及时给药（比值比：0.44）与较低死亡率相关。生存分析表明，给药时间对65-80岁患者的死亡率有影响（P=0.02），而在>80岁的患者中未观察到差异。这种影响在以呼吸困难为COVID-19主要症状的患者中更为明显，由于及时给药，其死亡率从57.1%降至38.3%（比值比：0.5；P=0.04）。
在65-80岁的COVID-19患者中，联合抗病毒方案与HCQ的使用且及时给药与较低死亡率之间存在显著关联。我们的研究结果支持及时开始治疗是COVID-19治疗的关键组成部分。
