COVID-19 related treatment and outcomes among COVID-19 ICU patients: A retrospective cohort study

Abstract

Background The COVID-19 pandemic remains an immediate and present concern, yet as of now there is still no approved therapeutic available for the treatment of COVID-19.This study aimed to investigate and report evidence concerning demographic characteristics and currently-used medications that contribute to the ultimate outcomes of COVID-19 ICU patients. Methods A retrospective cohort study was conducted among all COVID-19 patients in the Intensive Care Unit (ICU) of Asir Central Hospital in Saudi Arabia between the 1st and 30th of June 2020. Data extracted from patients’ medical records included their demographics, home medications, medications used to treat COVID-19, treatment durations, ICU stay, hospital stay, and ultimate outcome (recovery or death).Descriptive statistics and regression modelling were used to analyze and compare the results. The study was approved by the Institutional Ethics Committees at both Asir Central Hospital and King Khalid University. Results A total of 118 patients with median age of 57 years having definite clinical and disease outcomes were included in the study. Male patients accounted for 87% of the study population, and more than 65% experienced at least one comorbidity. The mean hospital and ICU stay was 11.4 and 9.8 days, respectively. The most common drugs used were tocilizumab (31.4%), triple combination therapy (45.8%), favipiravir (56.8%), dexamethasone (86.7%), and enoxaparin (83%). Treatment with enoxaparin significantly reduced the length of ICU stay (p = 0.04) and was found to be associated with mortality reduction in patients aged 50−75 (p = 0.03), whereas the triple regimen therapy and tocilizumab significantly increased the length of ICU stay in all patients (p = 0.01, p = 0.02 respectively). Conclusion COVID-19 tends to affect males more significantly than females. The use of enoxaparin is an important part of COVID-19 treatment, especially for those above 50 years of age, while the use of triple combination therapy and tocilizumab in COVID-19 protocols should be reevaluated and restricted to patients who have high likelihood of benefit.

Safety of Tocilizumab in COVID-19 Patients and Benefit of Single-Dose: The Largest Retrospective Observational Study

“…Although male patients represented a higher proportion of the nonsurvival groups, there was no significant difference in terms of gender. However, this observation was consistent with many studies [ 31 , 32 , 37 , 38 ]. Among studies that assessed the mortality of COVID-19 patients on tocilizumab in Saudi Arabia, our study reported an overall mortality of 21%.…”

“…In comparison, other studies reported 16.1% (n = 62) 28-day mortality [36]. In terms of mortality among ICU patients, the current study reported 38.5%, while other studies reported 31.1% (n = 61) [37] and 18.9% (n = 37) [38] mortality. However, worldwide, there is inconsistency in the percent of mortality of COVID 19 patients on tocilizumab, which in some studies has been reported to be as low as 13.4% (Asian-Indian) and up to 43.2% (American) [31,32,37,38].…”

“…In terms of mortality among ICU patients, the current study reported 38.5%, while other studies reported 31.1% (n = 61) [37] and 18.9% (n = 37) [38] mortality. However, worldwide, there is inconsistency in the percent of mortality of COVID 19 patients on tocilizumab, which in some studies has been reported to be as low as 13.4% (Asian-Indian) and up to 43.2% (American) [31,32,37,38]. This indicates the presence of many factors that can affect the response to the drug (e.g., pharmacogenomics, number of doses, age of the patients, and different guidelines for proper dosing and time of drug administration).…”

“…Nonsurvivors received more tocilizumab doses in terms of the number of doses, total mg administered, and total mg/kg, with 39.7% of them receiving at least three doses compared with 19.8% in the survivors’ group. None of the screened research mentioned using more than two doses of tocilizumab for comparison [ 31 , 32 , 38 ], except one study in which 2/120 patients received three doses [ 32 ] which makes the comparison difficult. However, in our study, subgroup analysis for patients who received one dose vs. patients who received two doses showed a significant increase in mortality in the latter group ( p = 0.000044, results not shown), which was not significant in the Morrison et al study [ 30 ].…”

Real-Life Use of Tocilizumab in the Treatment of Severe COVID-19 Pneumonia

“…The involvement of CRS in COVID-19 worsening is demonstrated by the increased proinflammatory factors that are seen in severe COVID-19 patients [ 9 ]. Studies report varying success rates of TCZ in patients with COVID-19 [ 10 – 14 ]. Predictors of poor outcome in COVID-19 patients receiving TCZ, according to studies conducted globally, include older age, comorbidities such as hypertension, diabetes mellitus, and immunosuppression, days from diagnosis until TCZ administration, elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), troponin I, and neutrophil levels [ 15 – 17 ].…”