Rozycki Elizabeth, Weiner Ashley, Malvestutto Carlos, Kman Nicholas E, Lustberg Mark, Dick Michael, Lehman K Joy, Schieber Ariane, Luca Lynne, Jordan Trisha A, Reed Erica E, Allen James, Parsons Jonathan, Nichols Courtney, Conroy Mark J
The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Hosp Pharm. 2022 Oct;57(5):639-645. doi: 10.1177/00185787211073466. Epub 2022 Feb 2.
Patients presenting for emergency department (ED) evaluation may be appropriate for treatment with monoclonal antibodies for mild to moderate COVID-19. While many sites have implemented infusion centers for these agents, EDs will continue to evaluate these patients where appropriate identification and efficient infusion of eligible patients is critical. Patients receiving bamlanivimab in the EDs of an academic medical center are described. The primary objective was to describe operational metrics and secondary objectives reported clinical outcomes. Patients receiving bamlanivimab and discharged from the ED were included from November 16, 2020 to January 16, 2021 in the retrospective, observational cohort. Primary outcome was adherence to institutional criteria. Secondary outcomes included ED visit metrics, clinical characteristics, and return visits within 30 days. Risk factors for return visits were assessed with regression. One hundred nineteen patients were included. Most (71%) were diagnosed with COVID-19 during the ED visit and median symptom duration was 3(IQR 2-5) days. Median number of risk factors for progression to severe disease was 2 (IQR 1-2). Thirty percent had a documented abnormal chest x-ray. Institutional criteria adherence was 99.2%. Median time from ED room to bamlanivimab was 4 (IQR 3.1-5.2) hours. Thirty patients had return visit within 30 days; 19 were COVID-19 related. Two multivariable regression models were analyzed for COVID-19 related return visit. Characteristics on ED presentation were considered in Model I: male gender (OR 3.01[0.97-9.31]), age (per 10 years) (OR 1.49[1.05-2.12]), African-American race (OR 3.46[1.09-11.06]), and symptom duration (per day) (OR 1.34[1.05-1.73]). Model II included labs and imaging acquired in ED. In Model II, age (per 10 years) (OR 1.52[1.07-2.16]) and abnormal CXR (OR 5.74[1.95-16.9]) were associated with COVID-19 related return visits. Administration of bamlanivimab to ED patients can be done efficiently, with the potential to reduce COVID-19 related return visits. Age and abnormal imaging were independent predictors of COVID-19 return visits.
前往急诊科（ED）进行评估的患者可能适合使用单克隆抗体治疗轻度至中度COVID-19。虽然许多机构已经设立了这些药物的输注中心，但急诊科仍将继续对这些患者进行评估，因为合适的患者识别和 eligible 患者的高效输注至关重要。描述了在一家学术医疗中心的急诊科接受巴瑞替尼治疗的患者情况。主要目标是描述操作指标，次要目标是报告临床结果。在回顾性观察队列中纳入了2020年11月16日至2021年1月16日期间在急诊科接受巴瑞替尼治疗并出院的患者。主要结局是符合机构标准。次要结局包括急诊就诊指标、临床特征以及30天内的复诊情况。通过回归分析评估复诊的危险因素。共纳入119例患者。大多数（71%）在急诊就诊期间被诊断为COVID-19，症状持续时间中位数为3（四分位间距2 - 5）天。进展为重症疾病的危险因素中位数为2（四分位间距1 - 2）。30%的患者胸部X线检查记录异常。机构标准符合率为99.2%。从急诊室到接受巴瑞替尼治疗的中位时间为4（四分位间距3.1 - 5.2）小时。30例患者在30天内复诊；19例与COVID-19相关。对两个多变量回归模型进行了与COVID-19相关复诊的分析。模型I考虑了急诊就诊时的特征：男性（比值比3.01[0.97 - 9.31]）、年龄（每增加10岁）（比值比1.49[1.05 - 2.12]）、非裔美国人种族（比值比3.46[1.09 - 11.06]）以及症状持续时间（每天）（比值比1.34[1.05 - 1.73]）。模型II纳入了在急诊科进行的实验室检查和影像学检查。在模型II中，年龄（每增加10岁）（比值比1.52[1.07 - 2.16]）和胸部X线异常（比值比5.74[1.95 - 16.9]）与COVID-19相关复诊有关。对急诊科患者使用巴瑞替尼可以高效进行，有可能减少与COVID-19相关的复诊情况。年龄和异常影像学检查是COVID-19复诊的独立预测因素。 （注：原文中“eligible”未翻译，因为不清楚其准确含义，可能是特定语境下的某个术语，需结合完整医学文献确定准确译法。）
