Outcomes of COVID-19 Patients Hospitalized at Acute Care Services: Real-World Experience in the New York Metropolitan Area During the Early Pandemic Before Initiation of Clinical Trials.

Autor:	Marsh K; Tisch Hospital Department of Pharmacy., Decano A; Brooklyn Hospital Department of Pharmacy., Siegfried J; Tisch Hospital Department of Pharmacy., Ahmed N; Brooklyn Hospital Department of Pharmacy., Blum S; Winthrop Hospital Department of Pharmacy, NYU Langone Health., Tirmizi S; Winthrop Hospital Department of Pharmacy, NYU Langone Health., Dong MQ; Bellevue Hospital Department of Pharmacy, NYC Health and Hospitals., Mehta D; Bellevue Hospital Department of Pharmacy, NYC Health and Hospitals., Pham VP; Division of Infectious Diseases, NYU Langone Health, New York, NY., Papadopoulos J; Tisch Hospital Department of Pharmacy., Dubrovskaya Y; Tisch Hospital Department of Pharmacy.
Jazyk:	angličtina
Zdroj:	Infectious diseases in clinical practice (Baltimore, Md.) [Infect Dis Clin Pract (Baltim Md)] 2021 Mar; Vol. 29 (2), pp. e88-e96. Date of Electronic Publication: 2020 Dec 29.
DOI:	10.1097/IPC.0000000000000982
Abstrakt:	As New York became the epicenter of the COVID-19 pandemic early on, clinicians were challenged to provide optimal medical and pharmaceutical care, despite the paucity of supporting literature and guidance. We sought to describe prescribing patterns and outcomes of physician response to the urgent need to treat COVID-19 patients before initiation of randomized clinical trials. Methods: This was a retrospective cohort study of adult patients with COVID-19 initially admitted to acute care services during March 2020. Critically ill patients requiring intensive care unit level of care on admission were excluded. Results: A total of 639 consecutive patients (supportive care, n = 247; treatment n = 392) were included in the analysis. Overall, the 28-day mortality rate was 12.2%. The mortality was 8.7% higher in the treatment group (15.6% vs 6.9% in the supportive care group, P < 0.001). Treatment was not protective against progression to severe disease (18.4% vs 3.6% with supportive care, P < 0.0001). Time to defervescence, duration of oxygen support, and hospital and intensive care unit (ICU) length of stay were also higher in the treatment group. In multivariate analysis, 60 years or older, presence of severe disease, and need for ICU admission were identified as independent predictors of 28-day mortality. There were 41 (10.5%) adverse event in the treatment group, with the majority being QT prolongation and gastrointestinal effects. Conclusions: In this cohort of hospitalized patients admitted to acute care services, treatment with hydroxychloroquine, lopinavir/ritonavir or both could not be shown to improve mortality, progression to severe disease, or clinical response. Competing Interests: Conflict of Interest: All authors have no conflicts of interest to disclose. (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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