Characteristics and outcomes of acute respiratory distress syndrome related to COVID-19 in Belgian and French intensive care units according to antiviral strategies: the COVADIS multicentre observational study

Abstract

Background Limited data are available regarding antiviral therapy efficacy in most severe patients under mechanical ventilation for Covid-19-related acute respiratory distress syndrome (ARDS). Methods Comparison of antiviral strategies (none, hydroxychloroquine (OHQ), lopinavir/ritonavir (L/R), others (combination or remdesivir) in an observational multicentre cohort of patients with moderate-to-severe Covid-19 ARDS. The primary endpoint was the number of day 28 ventilator-free days (VFD). Patients who died before d28 were considered as having 0 VFD. The variable was dichotomized into “patients still ventilated or dead at day 28” versus “patients weaned and alive at day 28”. Results We analyzed 415 patients (85 treated with standard of care (SOC), 57 with L/R, 220 with OHQ, and 53 others). The median number of d28-VFD was 0 (IQR 0–13) and differed between groups (P = 0.03), SOC patients having the highest d28-VFD. After adjustment for age, sex, Charlson Comorbidity Index, PaO2/FiO2 ratio and plateau pressure and accounting for center effect with a generalized linear mixed model, none of the antiviral strategies increased the chance of being alive and weaned from MV at day 28 compared to the SOC strategy (OR 0.48 CI95% (0.18–1.25); OR 0.96 (0.47–2.02) and OR 1.43 (0.53–4.04) for L/R, OHQ and other treatments, respectively). Acute kidney injury during ICU stay was frequent (55%); its incidence was higher in patients receiving lopinavir (66 vs 53%, P = 0.03). After adjustment for age, sex, BMI, chronic hypertension and chronic renal disease, the use of L/R was associated with an increased risk of renal replacement therapy (RRT). (OR 2.52 CI95% 1.16–5.59). Conclusion In this multicentre observational study of moderate-to-severe Covid-19 ARDS patients, we did not observe any benefit among patients treated with OHQ or L/R compared with SOC. The use of L/R treatment was associated with an increased need for RRT. Take home message Neither hydroxychloroquine nor lopinavir/ritonavir as COVID-19 antiviral treatment is associated with higher ventilator-free days at day 28 when compared with standard of care (no antiviral treatment) in ICU patients under invasive mechanical ventilation. Lopinavir/ritonavir is associated with an increased risk of renal replacement therapy requirement. Tweet COVID-19: Insights from ARDS cohort: no signal of efficacy of any antiviral drugs. Lopinavir/ritonavir may be associated with need for RRT

The Acquisition of Multidrug-Resistant Bacteria in Patients Admitted to COVID-19 Intensive Care Units: A Monocentric Retrospective Case Control Study

“…Therefore, it was not possible to use this population as control. Given the unusual duration of mechanical ventilation in COVID-19 patients [ 12 ] we compared them to patients obtained from a preexisting subarachnoid hemorrhage (SAH) institutional database cohort [ 13 ]. These patients were admitted to our ICU from January 2016–2019.…”

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – A narrative review

“…COVID-19-associated CARDS and prolonged mechanical ventilation not only imposes a major health burden on affected critically ill individuals, but also creates an unprecedented burden on society and global health care systems. Despite considerable geographical/regional variation, mortality from CARDS can range up to 30%–50% in developed countries [ 17 , [164] , [165] , [166] , [167] ]. In a recent European multicenter study in 4244 ICU patients, day-90 mortality increased along with the severity of CARDS at ICU admission (30%, 34%, 50% for mild, moderate, severe CARDS, respectively) [ 17 ].…”

Acute kidney injury in severe SARS-CoV-2 infection: An experience report in Eastern France

“…The renal toxicity of certain drugs used, such as lopinavir/ritonavir or remdesivir, cannot be ruled out. This has been little studied in COVID-19 patients even though a recent multicentre observational study suggested that use of lopinavir/ritonavir was associated with renal replacement therapy requirement [4] . The present results underline the need of mechanical ventilation support as a risk factor for the development of AKI.…”