Role of Low-Molecular-Weight Heparin in Hospitalized Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: A Prospective Observational Study.
ARDS
COVID-19
SARS-CoV-2
low-molecular weight
mortality
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:
Dec 2020
Dec 2020
Historique:
received:
09
08
2020
accepted:
18
11
2020
entrez:
28
12
2020
pubmed:
29
12
2020
medline:
29
12
2020
Statut:
epublish
Résumé
This study was conducted to evaluate the impact of low-molecular-weight heparin (LMWH) on the outcome of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. This is a prospective observational study including consecutive patients with laboratory-confirmed SARS-CoV-2 pneumonia admitted to the University Hospital of Pisa (March 4-April 30, 2020). Demographic, clinical, and outcome data were collected. The primary endpoint was 30-day mortality. The secondary endpoint was a composite of death or severe acute respiratory distress syndrome (ARDS). Low-molecular-weight heparin, hydroxychloroquine, doxycycline, macrolides, antiretrovirals, remdesivir, baricitinib, tocilizumab, and steroids were evaluated as treatment exposures of interest. First, a Cox regression analysis, in which treatments were introduced as time-dependent variables, was performed to evaluate the association of exposures and outcomes. Then, a time-dependent propensity score (PS) was calculated and a PS matching was performed for each treatment variable. Among 315 patients with SARS-CoV-2 pneumonia, 70 (22.2%) died during hospital stay. The composite endpoint was achieved by 114 (36.2%) patients. Overall, 244 (77.5%) patients received LMWH, 238 (75.5%) received hydroxychloroquine, 201 (63.8%) received proteases inhibitors, 150 (47.6%) received doxycycline, 141 (44.8%) received steroids, 42 (13.3%) received macrolides, 40 (12.7%) received baricitinib, 13 (4.1%) received tocilizumab, and 13 (4.1%) received remdesivir. At multivariate analysis, LMWH was associated with a reduced risk of 30-day mortality (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.21-0.6; This study suggests that LMWH might reduce the risk of in-hospital mortality and severe ARDS in coronavirus disease 2019. Randomized controlled trials are warranted to confirm these preliminary findings.
Sections du résumé
BACKGROUND
BACKGROUND
This study was conducted to evaluate the impact of low-molecular-weight heparin (LMWH) on the outcome of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.
METHODS
METHODS
This is a prospective observational study including consecutive patients with laboratory-confirmed SARS-CoV-2 pneumonia admitted to the University Hospital of Pisa (March 4-April 30, 2020). Demographic, clinical, and outcome data were collected. The primary endpoint was 30-day mortality. The secondary endpoint was a composite of death or severe acute respiratory distress syndrome (ARDS). Low-molecular-weight heparin, hydroxychloroquine, doxycycline, macrolides, antiretrovirals, remdesivir, baricitinib, tocilizumab, and steroids were evaluated as treatment exposures of interest. First, a Cox regression analysis, in which treatments were introduced as time-dependent variables, was performed to evaluate the association of exposures and outcomes. Then, a time-dependent propensity score (PS) was calculated and a PS matching was performed for each treatment variable.
RESULTS
RESULTS
Among 315 patients with SARS-CoV-2 pneumonia, 70 (22.2%) died during hospital stay. The composite endpoint was achieved by 114 (36.2%) patients. Overall, 244 (77.5%) patients received LMWH, 238 (75.5%) received hydroxychloroquine, 201 (63.8%) received proteases inhibitors, 150 (47.6%) received doxycycline, 141 (44.8%) received steroids, 42 (13.3%) received macrolides, 40 (12.7%) received baricitinib, 13 (4.1%) received tocilizumab, and 13 (4.1%) received remdesivir. At multivariate analysis, LMWH was associated with a reduced risk of 30-day mortality (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.21-0.6;
CONCLUSIONS
CONCLUSIONS
This study suggests that LMWH might reduce the risk of in-hospital mortality and severe ARDS in coronavirus disease 2019. Randomized controlled trials are warranted to confirm these preliminary findings.
Identifiants
pubmed: 33365358
doi: 10.1093/ofid/ofaa563
pii: ofaa563
pmc: PMC7717381
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofaa563Investigateurs
Agostini O Degl'Innocenti Sabrina
(AOD)
Antognoli Rachele
(A)
Baldassarri Rubia
(B)
Bertini Pietro
(B)
Biancalana Martina
(B)
Borselli Matteo
(B)
Brizzi Giulia
(B)
Calsolario Valeria
(C)
Carpene Nicoletta
(C)
Cinotti Francesco
(C)
Cipriano Alessandro
(C)
Della Rocca Alessandra
(DR)
Desideri Massimiliano
(D)
Forotti Giovanna
(F)
Gherardi Marco
(G)
Maggi Fabrizio
(M)
Mengozzi Alessandro
(M)
Malacarne Paolo
(M)
Masi Stefano
(M)
Monfroni Marco
(M)
Morea Alessandra
(M)
Nencini Elia
(N)
Park Naria
(P)
Paterni Simone
(P)
Piagnani Chiara
(P)
Ruberti Francesca
(R)
Sciuto Maria
(S)
Serradori Massimiliano
(S)
Spinelli Stefano
(S)
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
Références
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
JAMA. 2020 May 26;323(20):2052-2059
pubmed: 32320003
J Am Heart Assoc. 2015 Jan 06;4(1):e001595
pubmed: 25564372
J Thromb Haemost. 2020 Sep;18(9):2138-2144
pubmed: 32881336
Biometrics. 2005 Sep;61(3):721-8
pubmed: 16135023
Lancet Respir Med. 2020 Jul;8(7):681-686
pubmed: 32473124
JAMA. 2012 Jun 20;307(23):2526-33
pubmed: 22797452
Clin Infect Dis. 2020 Sep 12;71(6):1393-1399
pubmed: 32271369
J Thromb Haemost. 2020 May;18(5):1094-1099
pubmed: 32220112
JAMA. 2020 May 12;323(18):1824-1836
pubmed: 32282022
Intensive Care Med. 1996 Jul;22(7):707-10
pubmed: 8844239
Eur Heart J. 2012 Aug;33(15):1867-9
pubmed: 22745354
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
Clin Microbiol Infect. 2020 Nov;26(11):1572-1573
pubmed: 32565320
J Am Coll Cardiol. 2020 Jul 7;76(1):122-124
pubmed: 32387623
J Thromb Thrombolysis. 2016 Jan;41(1):165-86
pubmed: 26780745
J Am Coll Cardiol. 2014 Nov 4;64(18):1917-25
pubmed: 25444147
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Intensive Care Med. 2020 May;46(5):846-848
pubmed: 32125452
JAMA Netw Open. 2020 Jun 1;3(6):e2011192
pubmed: 32501489
Eur Respir J. 2020 May 7;55(5):
pubmed: 32269088
J Thromb Haemost. 2005 Apr;3(4):692-4
pubmed: 15842354
Clin Infect Dis. 2017 Jun 1;64(11):1486-1493
pubmed: 28205683