Consolaro Elena, Suter Fredy, Rubis Nadia, Pedroni Stefania, Moroni Chiara, Pastò Elena, Paganini Maria Vittoria, Pravettoni Grazia, Cantarelli Umberto, Perico Norberto, Perna Annalisa, Peracchi Tobia, Ruggenenti Piero, Remuzzi Giuseppe
Agenzia di Tutela della Salute (ATS) Insubria, Varese, Italy.
Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy.
Front Med (Lausanne). 2022 Apr 22;9:785785. doi: 10.3389/fmed.2022.785785. eCollection 2022.
While considerable success has been achieved in the management of patients hospitalized with severe coronavirus disease 2019 (COVID-19), far less progress has been made with early outpatient treatment. We assessed whether the implementation of a home treatment algorithm-designed based on a pathophysiologic and pharmacologic rationale-and including non-steroidal anti-inflammatory drugs, especially relatively selective cyclooxygenase-2 inhibitors and, when needed, corticosteroids, anticoagulants, oxygen therapy and antibiotics-at the very onset of mild COVID-19 symptoms could effectively reduce hospital admissions.
This fully academic, matched-cohort study evaluated outcomes in 108 consecutive consenting patients with mild COVID-19, managed at home by their family doctors between January 2021 and May 2021, according to the proposed treatment algorithm and in 108 age-, sex-, and comorbidities-matched patients on other therapeutic schedules (ClinicalTrials.gov: NCT04854824). The primary outcome was COVID-19-related hospitalization. Analyses were by intention-to-treat.
One (0.9%) patient in the "recommended" cohort and 12 (11.1%) in the "control" cohort were admitted to hospital ( = 0.0136). The proposed algorithm reduced the cumulative length of hospital stays by 85% (from 141 to 19 days) as well as related costs (from €60.316 to €9.058). Only 9.8 patients needed to be treated with the recommended algorithm to prevent one hospitalization event. The rate of resolution of major symptoms was numerically-but not significantly-higher in the "recommended" than in the "control" cohort (97.2 vs. 93.5%, respectively; = 0.322). Other symptoms lingered in a smaller proportion of patients in the "recommended" than in the "control" cohort (20.4 vs. 63.9%, respectively; < 0.001), and for a shorter period.
The adoption of the proposed outpatient treatment algorithm during the early, mild phase of COVID-19 reduced the incidence of subsequent hospitalization and related costs.
虽然在治疗新型冠状病毒肺炎（COVID-19）重症住院患者方面已取得相当大的成功，但在早期门诊治疗方面进展甚微。我们评估了基于病理生理和药理原理设计的家庭治疗方案——包括非甾体抗炎药，尤其是相对选择性的环氧化酶-2抑制剂，以及必要时使用的皮质类固醇、抗凝剂、氧疗和抗生素——在轻度COVID-19症状出现之初实施，是否能有效减少住院人数。
这项完全基于学术的匹配队列研究评估了2021年1月至2021年5月期间，108例连续同意参与研究的轻度COVID-19患者的治疗结果，这些患者由其家庭医生按照建议的治疗方案在家中进行治疗，以及108例年龄、性别和合并症匹配的采用其他治疗方案的患者（ClinicalTrials.gov：NCT04854824）。主要结局是与COVID-19相关的住院治疗。分析采用意向性分析。
“推荐”队列中有1例（0.9%）患者住院，“对照”队列中有12例（11.1%）患者住院（P = 0.0136）。建议的治疗方案使累计住院天数减少了85%（从141天降至19天），并降低了相关费用（从60316欧元降至9058欧元）。仅需9.8例患者采用推荐的治疗方案即可预防1例住院事件。“推荐”队列中主要症状的缓解率在数值上高于但无显著差异于“对照”队列（分别为97.2%和93.5%；P = 0.322）。“推荐”队列中其他症状持续存在的患者比例低于“对照”队列（分别为20.4%和63.9%；P < 0.001），且持续时间更短。
在COVID-19早期轻度阶段采用建议的门诊治疗方案可降低后续住院率及相关费用。
