San Diego State University School of Public Health, San Diego, California.
University of California - San Diego, School of Medicine, Department of Emergency Medicine, San Diego, California.
West J Emerg Med. 2022 Mar 17;23(3):302-311. doi: 10.5811/westjem.2021.10.52668.
To evaluate the effectiveness of bamlanivimab at reducing return emergency department (ED) visits in primarily Latinx/Hispanic patients with mild or moderate coronavirus disease 2019 (COVID-19). Secondary aims were to evaluate the prevention of subsequent hospitalizations and deaths in a resource-limited United States (U.S.)-Mexico border hospital.
We conducted a retrospective, open-label interventional study on 270 eligible adult patients diagnosed with mild-moderate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who met criteria for receiving bamlanivimab from November 1, 2020 to January 31, 2021. The main outcomes of 14-day return visits to the ED and hospitalizations due to COVID-19 were compared between two groups - those who received bamlanivimab (exposed group) and those who did not receive bamlanivimab (unexposed group). Outcomes were analyzed through chi-square tests followed by multivariate regression modeling to adjust for patient demographics, characteristics, and comorbidities.
There were 136 COVID-19 patients who received bamlanivimab in the ED prior to discharge and an unexposed group of 134 COVID-19 patients who were evaluated and discharged from the ED without receiving bamlanivimab. Overall, mean age was 61.7 (S.D. +/-13.9) years, mean body mass index (BMI) 31.0 (S.D. +/-6.6) kg/m, 91.5% identified as Latinx/Hispanic, 51.9% male, and 80.7% reported at least one comorbidity. Most commonly reported comorbidities were obesity (22.6%), hypertension (59.6%), and diabetes (41.1%). The bamlanivimab group had a 22.8% (mean estimate = 0.7717, 95% CI [0.6482, 0.8611]) risk reduction or 84.4% (0.3030, 95% CI = 0.166, 0.554, p=.0001) absolute reduction of ED return visits within 14 days compared to controls after adjusting for chronic kidney disease. The bamlanivimab group had 19.0% (mean estimate=0.8097, 95% CI [0.6451, 0.9087]) risk reduction or 96.2% (0.235, 95% CI 0.100, 0.550, p=0.0008) absolute reduction of subsequent hospitalizations compared to unexposed patients after adjusting for diabetes status.
Bamlanivimab infusions for high-risk COVID-19 patients in the ED substantially reduced the risk of return visits to the ED and hospitalizations in our primarily Latinx/Hispanic population. Monoclonal antibody infusions may help reduce hospital utilization during COVID-19 surges at U.S.-Mexico border hospitals.
评估巴伦利昔单抗在减少主要为拉丁裔/西班牙裔轻度或中度 2019 年冠状病毒病（COVID-19）患者急诊（ED）就诊方面的有效性。次要目标是评估在资源有限的美国-墨西哥边境医院中预防随后的住院和死亡。
我们对 270 名符合条件的成年患者进行了回顾性、开放性、干预性研究，这些患者被诊断为轻度至中度严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染，符合从 2020 年 11 月 1 日至 2021 年 1 月 31 日接受巴伦利昔单抗的标准。主要结局为 14 天内返回 ED 和因 COVID-19 住院。将接受巴伦利昔单抗治疗的两组患者（暴露组）和未接受巴伦利昔单抗治疗的两组患者（未暴露组）进行比较。通过卡方检验和多变量回归模型进行分析，以调整患者的人口统计学、特征和合并症。
在 ED 出院前，有 136 名 COVID-19 患者接受了巴伦利昔单抗治疗，有 134 名 COVID-19 患者在 ED 接受了评估并出院，未接受巴伦利昔单抗治疗。总体而言，平均年龄为 61.7（标准差 +/-13.9）岁，平均体重指数（BMI）为 31.0（标准差 +/-6.6）kg/m，91.5%为拉丁裔/西班牙裔，51.9%为男性，80.7%报告至少有一种合并症。最常见的合并症是肥胖症（22.6%）、高血压（59.6%）和糖尿病（41.1%）。巴伦利昔单抗组的 ED 就诊风险降低了 22.8%（平均估计值=0.7717，95%CI[0.6482，0.8611]），或调整慢性肾脏疾病后，绝对风险降低了 84.4%（0.3030，95%CI=0.166，0.554，p=0.0001），14 天内的 ED 就诊风险。调整糖尿病状态后，巴伦利昔单抗组的住院风险降低了 19.0%（平均估计值=0.8097，95%CI[0.6451，0.9087]），或绝对风险降低了 96.2%（0.235，95%CI 0.100，0.550，p=0.0008），与未暴露患者相比，随后的住院治疗。
在 ED 中为高危 COVID-19 患者输注巴伦利昔单抗可显著降低我们主要为拉丁裔/西班牙裔人群中 ED 就诊的风险。单克隆抗体输注可能有助于减少美国-墨西哥边境医院 COVID-19 激增期间的住院使用率。
