Clinical effectiveness of remdesivir in the treatment of moderate to severe and critical COVID-19 Infections: a retrospective study
Keywords:
Remdesivir, COVID-19, Thailand, retrospective cohort, effectivenessAbstract
Objectives: To evaluate clinical outcome on day 7 after treatment with remdesivir including discharge status, clinical outcome on day 14 after treatment with remdesivir and 30 days mortality in COVID 19 adult.
Methods: A retrospective cohort study was conducted between April 2021 to October 2021 at Nakornping hospital, Chiang Mai, Thailand. All hospitalized patients aged ≥16 years diagnosed with COVID-19 who received remdesivir, categorized in moderate to severe group and critical group. Clinical data including laboratory, radiographic finding and clinical course outcome were collected. Comparison was made between two groups by using Fisher’s exact test or chi square test when appropriate and t-test or Mann-Whitney U test to compare quantitative variables.
Results: A total of 156 COVID-19 patients were included in the analysis and classified into moderate to severe illness (n = 84) and critical illness (n = 72) groups. Baseline characteristics between groups were compared and found no significant difference except for age, underlying hypertension, chronic kidney disease and thyroid disease, chest radiography, hemoperfusion, C-reactive protein (CRP) and national early warning score (NEWS) at admission, treatments with antibiotics and venous thromboembolism (VTE) prophylaxis. For the primary endpoints, the proportion of patients discharge at day 7 was significantly higher in the moderate to severe group (32.1%) compared to the critical group (0%) (P = 0.015). For secondary endpoints, the proportion of patients discharge at day 14 was also significantly higher in the moderate to severe group (59.6%) compared to the critical group (11.1%) (P = 0.006). Thirty days mortality was significantly lower in the moderate to severe group (19.0%) compared to the critical group (32.6%) (P = 0.041).
Conclusion: Among COVID-19 patients with moderate to severe illness, remdesivir showed effects to improve clinical outcomes, but in COVID-19 patients with critical illness, remdesivir showed less benefit and clinical outcome improvement. More effective treatment options are suggested and should be considered especially in a critical group.
e improvement. More effective treatment options are suggested and should be considered especially in a
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