1
|
Chaugule A, Howard K, Simonson DC, McDonnell ME, Garg R, Gopalakrishnan G, Mitri J, Lebastchi J, Palermo NE, Westcott G, Weinstock RS. Predictors of readmission and mortality in adults with diabetes or stress hyperglycemia after initial hospitalization for COVID-19. BMJ Open Diabetes Res Care 2024; 12:e004167. [PMID: 38937276 PMCID: PMC11216067 DOI: 10.1136/bmjdrc-2024-004167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION We previously reported predictors of mortality in 1786 adults with diabetes or stress hyperglycemia (glucose>180 mg/dL twice in 24 hours) admitted with COVID-19 from March 2020 to February 2021 to five university hospitals. Here, we examine predictors of readmission. RESEARCH DESIGN AND METHODS Data were collected locally through retrospective reviews of electronic medical records from 1786 adults with diabetes or stress hyperglycemia who had a hemoglobin A1c (HbA1c) test on initial admission with COVID-19 infection or within 3 months prior to initial admission. Data were entered into a Research Electronic Data Capture (REDCap) web-based repository, and de-identified. Descriptive data are shown as mean±SD, per cent (%) or median (IQR). Student's t-test was used for comparing continuous variables with normal distribution and Mann-Whitney U test was used for data not normally distributed. X2 test was used for categorical variable. RESULTS Of 1502 patients who were alive after initial hospitalization, 19.4% were readmitted; 90.3% within 30 days (median (IQR) 4 (0-14) days). Older age, lower estimated glomerular filtration rate (eGFR), comorbidities, intensive care unit (ICU) admission, mechanical ventilation, diabetic ketoacidosis (DKA), and longer length of stay (LOS) during the initial hospitalization were associated with readmission. Higher HbA1c, glycemic gap, or body mass index (BMI) were not associated with readmission. Mortality during readmission was 8.0% (n=23). Those who died were older than those who survived (74.9±9.5 vs 65.2±14.4 years, p=0.002) and more likely had DKA during the first hospitalization (p<0.001). Shorter LOS during the initial admission was associated with ICU stay during readmission, suggesting that a subset of patients may have been initially discharged prematurely. CONCLUSIONS Understanding predictors of readmission after initial hospitalization for COVID-19, including older age, lower eGFR, comorbidities, ICU admission, mechanical ventilation, statin use and DKA but not HbA1c, glycemic gap or BMI, can help guide treatment approaches and future research in adults with diabetes.
Collapse
Affiliation(s)
| | - Kyra Howard
- Brown University, Providence, Rhode Island, USA
| | - Donald C Simonson
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Marie E McDonnell
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Rajesh Garg
- University of Miami School of Medicine, Miami, Florida, USA
- Harbor-UCLA Medical Center, Torrance, California, USA
| | | | - Joanna Mitri
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nadine E Palermo
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory Westcott
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
- Endocrinology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | |
Collapse
|
2
|
de Mesquita CF, Rivera A, Araújo B, Durães VL, Neto IQC, Carvalho VH, Haque T, Bes TM. Adjunctive Statin Therapy in Patients with Covid-19: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Med 2024:S0002-9343(24)00348-6. [PMID: 38866303 DOI: 10.1016/j.amjmed.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/22/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND The efficacy and safety of adjunctive statin therapy in hospitalized patients with coronavirus disease 2019 (Covid-19) remains uncertain. METHODS We systematically searched Medline, Embase, Cochrane, and ClinicalTrial.gov databases from March 2020 to late April 2024 for randomized controlled trials (RCTs) comparing statin versus no statin use in patients hospitalized with Covid-19. We pooled risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) applying a random-effects model. R version 4.3.1 was used for statistical analyses. RESULTS We included 7 RCTs comprising 4,262 patients, of whom 2,645 (62%) were randomized to receive statin therapy. Compared with no statin, statin use significantly reduced case-fatality rate (RR 0.88; 95% CI 0.80-0.98; I2=0%). In a time-to-event analysis, we found similar results (HR 0.86; 95% CI 0.75-0.99; I2=0%). Statin use also significantly reduced World Health Organization (WHO) scale at 14 days (mean difference -0.27; 95% CI -0.54 to -0.01; I2=0%). There was no statistically significant difference between the two groups in length of hospital stay, elevation of liver enzymes, and C-reactive protein levels. CONCLUSIONS In patients hospitalized with Covid-19, statins significantly reduced case-fatality rate and WHO scale score. PRIMARY FUNDING SOURCE No funding was used for this work. REGISTRATION A prospective register was recorded in International Prospective Register of Systematic Reviews (PROSPERO) with the number CRD42023479007.
Collapse
Affiliation(s)
| | - André Rivera
- Department of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil.
| | - Beatriz Araújo
- Department of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil
| | - Vitor Leão Durães
- Department of Medicine, Federal University of Pernambuco, Recife, Brazil
| | | | | | - Tahir Haque
- Division of General Internal Medicine, Brigham and Women's Hospital Harvard Medical School, United States of America
| | - Taniela M Bes
- Boston Medical Center, Department of Infectious Diseases, United States of America
| |
Collapse
|
3
|
Mohammadi K, Sleeman MW, Boyapati A, Bigdelou P, Geba GP, Fazio S. Effect of IL-6R blockade on plasma lipids and clinical outcomes among hospitalized patients with COVID-19 infection. J Lipid Res 2024; 65:100568. [PMID: 38795859 DOI: 10.1016/j.jlr.2024.100568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024] Open
Abstract
Plasma lipid levels are modulated by systemic infection and inflammation; it is unknown whether these changes reflect inflammatory responses or caused directly by pathogen presence. We explored the hypothesis that anti-inflammatory intervention via interleukin 6 receptor (IL-6R) blockade would influence plasma lipid levels during severe infection and evaluated the association of plasma lipid changes with clinical outcomes. Sarilumab (monoclonal antibody blocking IL-6R) efficacy was previously assessed in patients with coronavirus disease 2019 (COVID-19) (NCT04315298). This analysis determined whether strong inflammatory reduction by sarilumab in patients with COVID-19 pneumonia of increasing severity (severe, critical, multisystem organ dysfunction) affected plasma lipid changes between day 1 and day 7 of study therapy. Baseline lipid levels reflected the presence of acute systemic infection, characterized by very low HDL-C, low LDL-C, and moderately elevated triglycerides (TGs). Disease severity was associated with progressively more abnormal lipid levels. At day 7, median lipid levels increased more in the sarilumab versus placebo group (HDL-C +10.3%, LDL-C +54.7%, TG +32% vs. HDL-C +1.7%, LDL-C +15.4%, TG +8.8%, respectively). No significant association between lipid changes and clinical outcomes was observed. In conclusion, severe-to-critical COVID-19 pneumonia causes profound HDL-C depression that is only modestly responsive to strong anti-IL-6R inflammatory intervention. Conversely, LDL-C depression is strongly responsive to IL-6R blockade, with LDL-C levels likely returning to the predisease set point. These results advance our understanding of the complex relationship between serum lipids and infection/inflammation and suggest that HDL-C depression during acute contagious disease is driven by infection and not IL-6-mediated inflammation.
Collapse
Affiliation(s)
| | | | | | | | | | - Sergio Fazio
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA.
| |
Collapse
|
4
|
Alkhateeb T, Stollings JL, Sohn I, Liu D, Fleenor LM, Ely EW, Lahiri S. Tocilizumab is associated with reduced delirium and coma in critically ill patients with COVID-19. Sci Rep 2024; 14:11738. [PMID: 38778074 PMCID: PMC11111809 DOI: 10.1038/s41598-024-62505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
Recent preclinical studies demonstrate a direct pathological role for the interleukin-6 (IL-6) pathway in mediating structural and functional delirium-like phenotypes in animal models of acute lung injury. Tocilizumab, an IL-6 pathway inhibitor, has shown reduced duration of ventilator dependency and mortality in critically ill patients with COVID-19. In this study, we test the hypothesis that tocilizumab is associated with reduced delirium/coma prevalence in critically ill patients with COVID-19. 253 patients were included in the study cohort, 69 in the tocilizumab group and 184 in the historical control group who did not receive tocilizumab. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) with a positive score indicating delirium. Coma was defined as a Richmond Agitation-Sedation Scale score of - 4 or - 5. Tocilizumab was associated with significantly greater number of days alive without delirium/coma (tocilizumab [7 days (IQR: 3-9 days)] vs control [3 days (IQR: 1-8 days)]; p < 0.001). These results remained significant after adjusting for age, sex, sepsis, Charlson Comorbidity Index, Sequential Organ Failure Assessment score, and median daily dose of analgesics/sedatives ( β ^ = 0.671, p = 0.010). There were no significant differences in mortality ( β ^ = - 0.204, p = 0.561), ventilator duration ( β ^ = 0.016, p = 0.956), and ICU or hospital length of stay ( β ^ = - 0.134, p = 0.603; β ^ = 0.003, p = 0.991, respectively). Tocilizumab use was associated with significantly increased number of days without delirium/coma. Confirmation of these findings in randomized prospective studies may inform a novel paradigm of pharmacological amelioration of delirium/coma during critical illness.
Collapse
Affiliation(s)
- Tuqa Alkhateeb
- The Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joanna L Stollings
- The Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ine Sohn
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L Montana Fleenor
- The Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Wesley Ely
- The Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Shouri Lahiri
- Departments of Neurology, Neurosurgery, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA.
| |
Collapse
|
5
|
Aspide R, Berselli B, Piazza O, Recchia A, Bilotta F. Statins in Subarachnoid Hemorrhage to Prevent Delayed Cerebral Ischemia: Old Drugs for New Strategies? Neurocrit Care 2024:10.1007/s12028-024-01989-1. [PMID: 38684603 DOI: 10.1007/s12028-024-01989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Raffaele Aspide
- Anesthesia and Neurointensive Care Unit, Scientific Institute for Research, Hospitalization and Healthcare Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy.
| | - Bruno Berselli
- Anesthesia and Neurointensive Care Unit, Scientific Institute for Research, Hospitalization and Healthcare Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
| | - Ornella Piazza
- Department of Medicine, Surgery, Dentistry, University of Salerno, Fisciano, Italy
| | - Andreaserena Recchia
- Anesthesia and Intensive Care 2 Unit, Scientific Institute for Research, Hospitalization and Healthcare Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Federico Bilotta
- Department of Anesthesiology and Critical Care Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
6
|
Pijpe A, Papendorp SG, van der Heijden JW, Vermin B, Ertugrul I, Ritt MWJ, Stessel B, Callebaut I, Beishuizen A, Vlig M, Jimmink J, Huijgen HJ, van Zuijlen PPM, Middelkoop E, de Jong E. Efficacy of Alkaline Phosphatase in Critically Ill Patients with COVID-19: A Multicentre Investigator-Initiated Double-Blind Randomised Placebo-Controlled Trial. Biomedicines 2024; 12:723. [PMID: 38672081 PMCID: PMC11048668 DOI: 10.3390/biomedicines12040723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Efforts to identify therapies to treat hospitalised patients with COVID-19 are being continued. Alkaline phosphatase (AP) dephosphorylates pro-inflammatory adenosine triphosphate (ATP) into anti-inflammatory adenosine. METHODS In a randomised controlled trial, we investigated the safety and efficacy of AP in patients with SARS-CoV-2 infection admitted to the ICU. AP or a placebo was administered for four days following admission to the ICU. The primary outcome was the duration of mechanical ventilation. Mortality in 28 days, acute kidney injury, need for reintubation, safety, and inflammatory markers relevant to the described high cytokine release associated with SARS-CoV-2 infection were the secondary outcomes. RESULTS Between December 2020 and March 2022, 97 patients (of the intended 132) were included, of which 51 were randomised to AP. The trial was terminated prematurely based on meeting the threshold for futility. Compared to the placebo, AP did not affect the duration of mechanical ventilation (9.0 days vs. 9.3 days, p = 1.0). No safety issues were observed. After 28 days, mortality was 9 (18%) in the AP group versus 6 (13%) in the placebo group (p = 0.531). Additionally, no statistically significant differences between the AP and the placebo were observed for the other secondary outcomes. CONCLUSIONS Alkaline phosphatase (AP) therapy in COVID-19 ICU patients showed no significant benefits in this trial.
Collapse
Affiliation(s)
- Anouk Pijpe
- Department of Intensive Care, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (A.P.); (S.G.P.)
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location Vrije Universiteit, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (P.P.M.v.Z.); (E.M.)
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Association of Dutch Burn Centres, Zeestraat 27-29, 1941 AJ Beverwijk, The Netherlands;
- Burn Centre, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands;
| | - Stephan G. Papendorp
- Department of Intensive Care, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (A.P.); (S.G.P.)
- Burn Centre, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands;
| | - Joost W. van der Heijden
- Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands;
| | - Ben Vermin
- Department of Intensive Care Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands; (B.V.)
| | - Iris Ertugrul
- Department of Intensive Care Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands; (B.V.)
| | - Michael W. J. Ritt
- Department of Intensive Care, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (A.P.); (S.G.P.)
| | - Björn Stessel
- Department of Intensive Care Medicine, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium; (B.S.); (I.C.)
- LCRC, Faculty of Medicine and Life Sciences, University Hasselt, Agoralaan, 3590 Diepenbeek, Belgium
| | - Ina Callebaut
- Department of Intensive Care Medicine, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium; (B.S.); (I.C.)
- LCRC, Faculty of Medicine and Life Sciences, University Hasselt, Agoralaan, 3590 Diepenbeek, Belgium
| | - Albertus Beishuizen
- Intensive Care Center, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ Enschede, The Netherlands;
| | - Marcel Vlig
- Association of Dutch Burn Centres, Zeestraat 27-29, 1941 AJ Beverwijk, The Netherlands;
| | - Joost Jimmink
- Burn Centre, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands;
| | - Henk J. Huijgen
- Department of Clinical Chemistry, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands;
| | - Paul P. M. van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location Vrije Universiteit, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (P.P.M.v.Z.); (E.M.)
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Burn Centre, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands;
- Department of Plastic Reconstructive and Hand Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands
- Emma Children’s Hospital, Pediatric Surgical Center, Amsterdam UMC Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location Vrije Universiteit, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (P.P.M.v.Z.); (E.M.)
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Association of Dutch Burn Centres, Zeestraat 27-29, 1941 AJ Beverwijk, The Netherlands;
- Burn Centre, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands;
| | - Evelien de Jong
- Department of Intensive Care, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (A.P.); (S.G.P.)
- Burn Centre, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands;
| |
Collapse
|
7
|
The Rise of Adaptive Platform Trials in Critical Care. Am J Respir Crit Care Med 2024; 209:491-496. [PMID: 38271622 PMCID: PMC10919116 DOI: 10.1164/rccm.202401-0101cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 01/27/2024] Open
Abstract
As durable learning research systems, adaptive platform trials represent a transformative new approach to accelerating clinical evaluation and discovery in critical care. This Perspective provides a brief introduction to the concept of adaptive platform trials, describes several established and emerging platforms in critical care, and surveys some opportunities and challenges for their implementation and impact.
Collapse
|
8
|
Eltahan NH, Elsawy NH, Abdelaaty KM, Elhamaky AS, Hassan AH, Emara MM. Atorvastatin for reduction of 28-day mortality in severe and critical COVID-19 patients: a randomized controlled trial. Respir Res 2024; 25:97. [PMID: 38389078 PMCID: PMC10885389 DOI: 10.1186/s12931-024-02732-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND COVID-19 is an abnormal host response to the SARS-CoV-2 infection, which is associated with endothelial dysfunction and multi-organ failure. Atorvastatin has been proposed to reduce COVID-19 severity and mortality in chronic and de-novo users. METHODS This randomized double-blind trial included 220 COVID-19 patients admitted to Mansoura University's isolation hospital in Egypt. One hundred and ten cases were given 40 mg of atorvastatin once daily for 28 days (group A), while 110 received a placebo (group B). All patients received treatment as per hospital protocol. The primary outcome is all-cause mortality at 28 days. We also tracked 6-month mortality, time to clinical improvement, the risk of invasive mechanical ventilation, acute kidney injury, potential adverse events, and hospital and intensive care length of stay. RESULTS The 28-day all-cause mortality was 52/104 (50%) in group A vs. 54/103 (52.4%) in group B, odds ratio (OR) = 0.907 (0.526, 1.565), P = 0.727; adjusted OR = 0.773 (0.407, 1.47), P = 0.433. Six-month mortality occurred in 53/102 (52%) and 59/79 (60.8%) in group A vs. B, respectively, P = 0.208. Among hospital survivors in group A vs. group B, the median time to clinical improvement was 10 days (7-14) vs. 10 (7-15), P = 0.715; the duration of hospital stay was 10 days (7-14) vs. 10 (8-17), P = 0.378. Discontinuation was higher in group B (four vs. one), but statistically insignificant, P = 0.369. CONCLUSIONS In adults with severe or critical COVID-19, atorvastatin did not reduce the risk of 28-day or 6-month mortality and did not shorten the length of hospital stay or time to clinical improvement. Trial registration Clinical Trial Registry (NCT04952350) on July 1st, 2021. https://clinicaltrials.gov/ct2/show/NCT04952350.
Collapse
Affiliation(s)
| | - Neamat Hamdy Elsawy
- Fowa Health District, Preventive Sector, Epidemiology and Surveillance Department, Ministry of Health and Population, Fowa, Egypt
- Department of Clinical Research, Fowa Central Hospital, Ministry of Health and Population, Fowa, Egypt
| | | | - Amal Salah Elhamaky
- Mansoura Specialized Hospital, Mansoura, Ministry of Health and Population, Mansoura, Egypt
| | - Ahmed H Hassan
- Mansoura University, Mansoura University Hospital, Mansoura, Egypt
| | - Moataz Maher Emara
- Department of Anesthesiology and Intensive Care and Pain Medicine, Mansoura University Faculty of Medicine, 60 Elgomhoria St, Mansoura, 35516, Egypt.
| |
Collapse
|
9
|
Moskowitz A, Gong MN. Balancing Act - Probability, Precision, and the Future of Critical Care Trials in ARDS. N Engl J Med 2023; 389:2391-2392. [PMID: 38118031 DOI: 10.1056/nejme2312635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Affiliation(s)
- Ari Moskowitz
- From the Montefiore Medical Center and Albert Einstein College of Medicine - both in Bronx, NY
| | - Michelle N Gong
- From the Montefiore Medical Center and Albert Einstein College of Medicine - both in Bronx, NY
| |
Collapse
|