Remdesivir Use in Patients Requiring Mechanical Ventilation due to COVID-19.
COVID-19
SARS-CoV-2
antiviral treatment
coronavirus
critically ill patients
intensive care unit
remdesivir
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
18
08
2020
accepted:
06
10
2020
entrez:
18
11
2020
pubmed:
19
11
2020
medline:
19
11
2020
Statut:
epublish
Résumé
Remdesivir has been associated with accelerated recovery of severe coronavirus disease 2019 (COVID-19). However, whether it is also beneficial in patients requiring mechanical ventilation is uncertain. All consecutive intensive care unit (ICU) patients requiring mechanical ventilation due to COVID-19 were enrolled. Univariate and multivariable Cox models were used to explore the possible association between in-hospital death or hospital discharge, considered competing-risk events, and baseline or treatment-related factors, including the use of remdesivir. The rate of extubation and the number of ventilator-free days were also calculated and compared between treatment groups. One hundred thirteen patients requiring mechanical ventilation were observed for a median of 31 days of follow-up; 32% died, 69% were extubated, and 66% were discharged alive from the hospital. Among 33 treated with remdesivir (RDV), lower mortality (15.2% vs 38.8%) and higher rates of extubation (88% vs 60%), ventilator-free days (median [interquartile range], 11 [0-16] vs 5 [0-14.5]), and hospital discharge (85% vs 59%) were observed. Using multivariable analysis, RDV was significantly associated with hospital discharge (hazard ratio [HR], 2.25; 95% CI, 1.27-3.97; In our cohort of mechanically ventilated patients, RDV was not associated with a significant reduction of mortality, but it was consistently associated with shorter duration of mechanical ventilation and higher probability of hospital discharge, independent of other risk factors.
Sections du résumé
BACKGROUND
BACKGROUND
Remdesivir has been associated with accelerated recovery of severe coronavirus disease 2019 (COVID-19). However, whether it is also beneficial in patients requiring mechanical ventilation is uncertain.
METHODS
METHODS
All consecutive intensive care unit (ICU) patients requiring mechanical ventilation due to COVID-19 were enrolled. Univariate and multivariable Cox models were used to explore the possible association between in-hospital death or hospital discharge, considered competing-risk events, and baseline or treatment-related factors, including the use of remdesivir. The rate of extubation and the number of ventilator-free days were also calculated and compared between treatment groups.
RESULTS
RESULTS
One hundred thirteen patients requiring mechanical ventilation were observed for a median of 31 days of follow-up; 32% died, 69% were extubated, and 66% were discharged alive from the hospital. Among 33 treated with remdesivir (RDV), lower mortality (15.2% vs 38.8%) and higher rates of extubation (88% vs 60%), ventilator-free days (median [interquartile range], 11 [0-16] vs 5 [0-14.5]), and hospital discharge (85% vs 59%) were observed. Using multivariable analysis, RDV was significantly associated with hospital discharge (hazard ratio [HR], 2.25; 95% CI, 1.27-3.97;
CONCLUSIONS
CONCLUSIONS
In our cohort of mechanically ventilated patients, RDV was not associated with a significant reduction of mortality, but it was consistently associated with shorter duration of mechanical ventilation and higher probability of hospital discharge, independent of other risk factors.
Identifiants
pubmed: 33204761
doi: 10.1093/ofid/ofaa481
pii: ofaa481
pmc: PMC7651598
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofaa481Investigateurs
Alessandra Gambaro
(A)
Anna Spolti
(A)
Ilaria Beretta
(I)
Luca Bisi
(L)
Anna Cappelletti
(A)
Elisabetta Chiesa
(E)
Viola Cogliandro
(V)
Paola Columpsi
(P)
Sergio Foresti
(S)
Giulia Gustinetti
(G)
Francesca Iannuzzi
(F)
Ester Pollastri
(E)
Marianna Rossi
(M)
Francesca Sabbatini
(F)
Nicola Squillace
(N)
Daniela Ferlicca
(D)
Fabrizia Mauri
(F)
Marco Giani
(M)
Matteo Pozzi
(M)
Vincenzo Russotto
(V)
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
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