Impact of remdesivir according to the pre-admission symptom duration in patients with COVID-19.

Adenosine Monophosphate / analogs & derivatives Aged Alanine / analogs & derivatives Antiviral Agents / therapeutic use Humans Male Respiration, Artificial Retrospective Studies SARS-CoV-2 COVID-19 Drug Treatment

Journal

The Journal of antimicrobial chemotherapy

ISSN: 1460-2091

Titre abrégé: J Antimicrob Chemother

Pays: England

ID NLM: 7513617

Informations de publication

Date de publication:
12 11 2021

Historique:

received: 22 05 2021

accepted: 08 08 2021

pubmed: 3 9 2021

medline: 23 11 2021

entrez: 2 9 2021

Statut: ppublish

Résumé

The use of remdesivir has demonstrated a significant reduction in the time to recovery in patients with COVID-19. However, the impact on mortality is still controversial. Therefore, it is necessary to evaluate whether there is a specific subgroup of patients in whom an active antiviral therapy also reduces the mortality. Patients admitted for >48 h in our hospital for a SARS-CoV-2 confirmed or suspected infection from February 2020 to February 2021 were retrospectively analysed. The primary outcome of the study was mortality at 30 days. Univariate and multivariate analyses were performed to identify predictors of mortality. In total, 2607 patients (438 receiving remdesivir and 2169 not) were included with a median (IQR) age of 65 (54-77) years and 58% were male. Four hundred and seventy-six were admitted to the ICU (18.3%) and 264 required invasive mechanical ventilation (10.1%). The global 30 day mortality rate was 10.7%. Pre-admission symptom duration of 4-6 days and ≤3 days was associated with a 1.5- and 2.5-fold increase in the mortality rate, respectively, in comparison with >6 days and treatment with remdesivir was independently associated with a lower mortality rate (OR = 0.382, 95% CI = 0.218-0.671). The analysis showed that the major difference was among patients with shorter pre-admission symptom duration (<6 days). Patients with ≤3 days and 4-6 days from symptom onset to admission are associated with a 2.5- and 1.5-fold higher risk of death, respectively. Remdesivir was associated with 62% reduced odds of death versus standard-of-care and its survival benefit increased with shorter duration of symptoms.

Sections du résumé

BACKGROUND

METHODS

Patients admitted for >48 h in our hospital for a SARS-CoV-2 confirmed or suspected infection from February 2020 to February 2021 were retrospectively analysed. The primary outcome of the study was mortality at 30 days. Univariate and multivariate analyses were performed to identify predictors of mortality.

RESULTS

In total, 2607 patients (438 receiving remdesivir and 2169 not) were included with a median (IQR) age of 65 (54-77) years and 58% were male. Four hundred and seventy-six were admitted to the ICU (18.3%) and 264 required invasive mechanical ventilation (10.1%). The global 30 day mortality rate was 10.7%. Pre-admission symptom duration of 4-6 days and ≤3 days was associated with a 1.5- and 2.5-fold increase in the mortality rate, respectively, in comparison with >6 days and treatment with remdesivir was independently associated with a lower mortality rate (OR = 0.382, 95% CI = 0.218-0.671). The analysis showed that the major difference was among patients with shorter pre-admission symptom duration (<6 days).

CONCLUSIONS

Patients with ≤3 days and 4-6 days from symptom onset to admission are associated with a 2.5- and 1.5-fold higher risk of death, respectively. Remdesivir was associated with 62% reduced odds of death versus standard-of-care and its survival benefit increased with shorter duration of symptoms.

Identifiants

DOI: 10.1093/jac/dkab321 PMID: 34473275 PMC: PMC8499897

pubmed: 34473275

pii: 6362683

doi: 10.1093/jac/dkab321

pmc: PMC8499897

doi:

Substances chimiques

Antiviral Agents 0

remdesivir 3QKI37EEHE

Adenosine Monophosphate 415SHH325A

Alanine OF5P57N2ZX

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

3296-3302

Subventions

Organisme : Hospital Clínic de Barcelona-Fundació Clínic per a la Recerca Biomèdica

Investigateurs

J L Blanco (JL)

J Mallolas (J)

E Martínez (E)

M Martínez (M)

J M Miró (JM)

A Moreno (A)

M Solá (M)

A Ugarte (A)

A Gonzalez-Cordón (A)

M Laguno (M)

L Leal (L)

J Rojas (J)

B Torres (B)

S Fernandez (S)

A Tellez (A)

F Fuentes (F)

M Ayala (M)

D Campubri (D)

M T de Alba (MT)

M Fernandez (M)

E Ferrer (E)

B Grau (B)

H Marti (H)

M Muelas (M)

M J Pinazo (MJ)

N Rodriguez (N)

M Roldan (M)

C Subira (C)

I Vera (I)

N Williams (N)

A Almuedo-Riera (A)

J Muñoz (J)

A Aldea (A)

M Camafort (M)

J Calvo (J)

A Capdevila (A)

F Cardellach (F)

I Carbonell (I)

E Coloma (E)

A Foncillas (A)

R Estruch (R)

M Feliu (M)

J Fernández-Solá (J)

I Fuertes (I)

C Gabara (C)

I Grafia (I)

A Ladino (A)

R López-Alfaro (R)

A López-Soto (A)

I Macaya (I)

F Masanés (F)

A Matas (A)

M Navarro (M)

J Marco-Hernández (J)

L Miguel (L)

J C Milisenda (JC)

P Moreno (P)

J Naval (J)

D Nicolás (D)

H Oberoi (H)

J Padrosa (J)

S Prieto-González (S)

M Pellicé (M)

J Ribot (J)

O Rodríguez-Núnez (O)

E Sacanella (E)

F Seguí (F)

C Sierra (C)

A Tomé (A)

M Torres (M)

H Ventosa (H)

C Zamora-Martínez (C)

M Almela (M)

M Alvarez (M)

J Bosch (J)

J Costa (J)

G Cuesta (G)

B Fidalgo (B)

J Gonzàlez (J)

F Marco (F)

S Narvaez (S)

C Pitart (C)

E Rubio (E)

A Vergara (A)

M E Valls (ME)

Y Zboromyrska (Y)

Informations de copyright

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.