Shao Jiasheng, Fan Rong, Guo Chengnan, Huang Xuyuan, Guo Runsheng, Zhang Fengdi, Hu Jianrong, Huang Gang, Cao Liou
Department of Immunology and Rheumatology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai 201899, China.
Tulane National Primate Research Center, Tulane University School of Medicine, 18703 Three Rivers Road, Covington, LA 70433, USA.
Microorganisms. 2023 Jul 23;11(7):1859. doi: 10.3390/microorganisms11071859.
: The sixty-day effects of initial composite interventions for the treatment of severely and critically ill patients with COVID-19 are not fully assessed. : Using a Bayesian piecewise exponential model, we analyzed the 60-day mortality, health-related quality of life (HRQoL), and disability in 1082 severely and critically ill patients with COVID-19 between 8 December 2022 and 9 February 2023 in Shanghai, China. The final 60-day follow-up was completed on 10 April 2023. : Among 1082 patients (mean age, 78.0 years, 421 [38.9%] women), 139 patients (12.9%) died within 60 days. Azvudine had a 99.8% probability of improving 2-month survival (adjusted HR, 0.44 [95% credible interval, 0.24-0.79]), and Paxlovid had a 91.9% probability of improving 2-month survival (adjusted HR, 0.71 [95% credible interval, 0.44-1.14]) compared with the control. IL-6 receptor antagonist, baricitinib and a-thymosin each had a high probability of benefit (99.5%, 99.4%, and 97.5%, respectively) compared to their controls, while the probability of trail-defined statistical futility (HR > 0.83) was high for therapeutic anticoagulation (99.8%; HR, 1.64 [95% CrI, 1.06-2.50]) and glucocorticoid (91.4%; HR, 1.20 [95% CrI, 0.71-2.16]). Paxlovid, Azvudine, and therapeutic anticoagulation showed a significant reduction in disability ( < 0.05) : Among severely and critically ill patients with COVID-19 who received 1 or more therapeutic interventions, treatment with Azvudine had a high probability of improved 60-day mortality compared with the control, indicating its potential in a resource-limited scenario. Treatment with an IL-6 receptor antagonist, baricitinib, and a-thymosin also had high probabilities of benefit in improving 2-month survival, among which a-thymosin could improve HRQoL. Treatment with Paxlovid, Azvudine, and therapeutic anticoagulation could significantly reduce disability at day 60.
对于新型冠状病毒肺炎（COVID-19）重症和危重症患者，初始综合干预措施的60天效果尚未得到充分评估。我们采用贝叶斯分段指数模型，分析了2022年12月8日至2023年2月9日期间在中国上海的1082例COVID-19重症和危重症患者的60天死亡率、健康相关生活质量（HRQoL）和残疾情况。最终的60天随访于2023年4月10日完成。在1082例患者（平均年龄78.0岁，421例[38.9%]为女性）中，139例患者（12.9%）在60天内死亡。与对照组相比，阿兹夫定改善2个月生存率的概率为99.8%（调整后HR，0.44[95%可信区间，0.24 - 0.79]），帕罗韦德改善2个月生存率的概率为91.9%（调整后HR，0.71[95%可信区间，0.44 - 1.14]）。与各自对照组相比，白细胞介素-6受体拮抗剂、巴瑞替尼和α-胸腺肽各自具有较高的获益概率（分别为99.5%、99.4%和97.5%），而治疗性抗凝（99.8%；HR，1.64[95%CrI，1.06 - 2.50]）和糖皮质激素（91.4%；HR，1.20[95%CrI，0.71 - 2.16]）出现试验定义的统计无效性（HR > ）的概率较高。帕罗韦德、阿兹夫定和治疗性抗凝在残疾方面有显著降低（< 0.05）。在接受1种或更多治疗性干预的COVID-19重症和危重症患者中，与对照组相比，阿兹夫定治疗有较高概率改善60天死亡率，表明其在资源有限情况下的潜力。白细胞介素-6受体拮抗剂、巴瑞替尼和α-胸腺肽治疗在改善2个月生存率方面也有较高的获益概率，其中α-胸腺肽可改善HRQoL。帕罗韦德、阿兹夫定和治疗性抗凝治疗可在第60天显著降低残疾程度。
