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

Abstract

Background 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. 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.

Angiotensin Converting Enzyme Inhibitors May Increase While Active Vitamin D May Decrease the Risk of Severe Pneumonia in SARS-CoV-2 Infected Patients with Chronic Kidney Disease on Maintenance Hemodialysis

“…Identifying patients with rapidly developing pneumonia and a high risk of developing acute respiratory distress syndrome (ARDS) as soon as possible might help individualize pharmacological treatment and optimal utilization of medical resources. It was demonstrated that the sooner pharmacological treatment is started in such patients, the greater are the chances of survival [ 15 , 16 , 17 , 18 ]. We found that patients with more extensive lung changes on admission objectified by a higher TSS were likely to present with fever, had decreased finger oxygen saturation and arterial oxygen partial pressure, increased laboratory indicators of inflammation including serum c-reactive protein and ferritin, and decreased lymphocytes count.…”

“…In addition, HD patients are characterized by impaired innate immunity and a worse humoral and cellular response to vaccines than in the general population [ 12 , 13 , 14 ]. Various methods of pharmacological treatment, including inhaled steroids, casirivimab-imdevimab, remdesivir, and tocilizumab are highly hoped for, which, as research shows, if applied early enough, can significantly improve the prognosis [ 15 , 16 , 17 , 18 ]. Therefore, the need to identify patients infected with SARS-CoV-2 and those who develop pneumonia, which may be fatal or have persistent sequelae, remains as urgent as possible.…”

Clinical Presentation and Outcome of COVID-19 in a Latin American Versus Spanish Population: Matched Case-Control Study

“…Data were retrospectively collected for all patients included in the study from the electronic health records (EHRs). An intelligent system was used to retrieve the high-quality data from EHRs (SILDv1.0 system, S34M @ ) as previously described [ 8 ]. Variables included were: age, gender, pre-admission duration of symptoms in days, co-morbidities (hypertension, chronic heart disease, diabetes mellitus, chronic liver disease, chronic kidney disease, chronic obstructive pulmonary disease, haematological and solid neoplasia), respiratory rate and ambient air arterial oxygen saturation (SaO 2 ) measured with a pulse oximeter at admission, creatinine, lymphocyte count, C-reactive protein (C-RP), lactate dehydrogenase (LDH), d -dimer, ferritin and procalcitonin within the first 24 h from hospital admission.…”

“…We looked for controls born in Spain with the same age and gender among the 3216 patients recorded in our previously described database [ 8 ]. No other variables were used for matching patients.…”

Pharmacological treatment of COVID-19: an opinion paper

“…In an observational study carried out in Spain at the Hospital Clínico de Barcelona, the use of remdesivir improved survival, with greater efficacy in patients who received treatment earlier, with a total reduction in the risk of death of 62% [ 16 ]. Other studies showed similar results, such that treated patients had less need for mechanical ventilation and lower mortality [ 17 , 18 ].…”