Liu Bin, Yang Mingjin, Xu Li, Li Yishi, Cai Jing, Xie Bo, Zong Kaican, Guo Shuliang
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi Rd 1, Yuzhong, Chongqing 400016, China; Department of Respiratory and Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, No. 116, Changjiang South Road, Tianyuan District, Zhuzhou, Hunan 412007, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi Rd 1, Yuzhong, Chongqing 400016, China.
Int Immunopharmacol. 2023 Nov;124(Pt A):110824. doi: 10.1016/j.intimp.2023.110824. Epub 2023 Aug 24.
Several studies have found that azvudine (FNC) can inhibit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication both in vivo and in vitro. However, the effect of FNC on the risk of death in patients with coronavirus disease 2019 (COVID-19) is unclear. This study aims to investigate the effect of FNC on the risk of death in patients with coronavirus disease 2019 (COVID-19).
Charts of consecutive patients hospitalized at five hospitals in Chongqing with confirmed COVID-19. The primary outcome of the study was 28-day mortality. Secondary outcomes were: ICU admission rates, length of hospital and ICU stay, and also the range of mechanical ventilation days when admission. We compared primary outcome in patients who received FNC with those in patients who did not, using a multivariable model with inverse probability weighting according to the propensity score.
We included 1,110 patients in our study cohort. Of the 236 patients treated with FNC, 30 died within 28 days (12.7%), and of the 874 patients not treated with FNC, 206 died within 28 days (23.6%). In the crude, unadjusted analysis, a significant beneficial effect of FNC in terms of the 28-day mortality (OR 0.472, 95% CI 0.312-0.714; p < 0.001) in the overall population was detected. The adjusted odds ratio by multivariate analysis was (OR 0.498, 95% CI 0.287-0.864; p = 0.013). In the multivariate analysis with inverse probability weighting according to the propensity score, a significantly beneficial effect of FNC in terms of the 28-day mortality was further confirmed (OR 0.754, 95% CI 0.614-0.925; p = 0.007). Moreover, multivariable propensity-score analyses with matching also yielded similar results (OR 0.438, 95% CI 0.246-0.778; p = 0.005).
Our results reveal that in patients with COVID-19, FNC administration was associated with a significantly reduced 28-day mortality.
多项研究发现，阿兹夫定（FNC）在体内和体外均可抑制严重急性呼吸综合征冠状病毒2（SARS-CoV-2）复制。然而，FNC对2019冠状病毒病（COVID-19）患者死亡风险的影响尚不清楚。本研究旨在探讨FNC对2019冠状病毒病（COVID-19）患者死亡风险的影响。
收集重庆五家医院连续收治的确诊COVID-19患者的病历。本研究的主要结局为28天死亡率。次要结局包括：重症监护病房（ICU）入住率、住院时间和ICU住院时间，以及入院时机械通气天数范围。我们根据倾向评分，使用具有逆概率加权的多变量模型，比较接受FNC治疗的患者与未接受FNC治疗的患者的主要结局。
我们的研究队列纳入了1110例患者。在236例接受FNC治疗的患者中，30例在28天内死亡（12.7%）；在874例未接受FNC治疗的患者中，206例在28天内死亡（23.6%）。在未经调整的粗分析中，检测到FNC对总体人群28天死亡率有显著有益影响（OR=0.472，95%CI 0.312-0.714；p<0.001）。多变量分析调整后的优势比为（OR=0.498，95%CI 0.287-0.864；p=0.013）。在根据倾向评分进行逆概率加权的多变量分析中，进一步证实了FNC对28天死亡率有显著有益影响（OR=0.754，95%CI 0.614-0.925；p=0.007）。此外，匹配的多变量倾向评分分析也得出了类似结果（OR=0.438，95%CI 0.246-0.778；p=0.005）。
我们的结果表明，在COVID-19患者中，使用FNC与28天死亡率显著降低相关。
