Is It Time to Revisit Remdesivir Use for Severe COVID-19?

COVID-19 Mortality and Remdesivir - A Retrospective Cohort in Intensive Care Setting

BACKGROUND

Remdesivir is a broad-spectrum antiviral drug that received emergency use authorization in the first wave of the COVID-19 pandemic. However, its effectiveness in preventing mortality in COVID-19 patients who required intensive care was unclear.

PATIENTS AND METHODS

We retrospectively analyzed clinical data of 302 patients from intensive care units of a quaternary care center with moderate to severe COVID-19 illness and followed them until discharge between March 2020 and February 2021. Participants who received at least five doses of Remdesivir were compared against participants who received standard care. The primary outcome was all-cause mortality. Secondary outcomes included invasive mechanical ventilation, clinical worsening, and intensive care stay.

RESULTS

Remdesivir use was not associated with all-cause mortality in this cohort (age and sex-adjusted OR = 0.76, 95% CI 0.4 -1.5, p = 0.409). However, when stratified for clinical severity and steroid use, Remdesivir demonstrated a strong negative association with all-cause mortality in severely ill patients (OR 0.3, 95% CI 0.1 - 0.6, p = 0.003) or when used along with intravenous Methylprednisolone (Infusion/Bolus, OR 0.2/0.3, 95% CI 0.1 - 0.9 p = 0.06). Remdesivir use was not significantly associated with invasive mechanical ventilation or clinical worsening but with prolonged ICU stay.

CONCLUSION

While Remdesivir use may not affect all-cause mortality in moderate to severely ill COVID-19 ICU patients, it may still benefit severely ill patients or when used with intravenous steroids. However, the limitations of the present study necessitate a randomized controlled trial to test this combined intervention strategy.

COVID-19 and Acute Ischemic Stroke Mortality and Clinical Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample

Coronavirus-19, primarily a respiratory virus, also affects the nervous system. Acute ischemic stroke (AIS) is a well-known complication among COVID-19 infections, but large-scale studies evaluating AIS outcomes related to COVID-19 infection remain limited. We used the National Inpatient Sample database to compare acute ischemic stroke patients with and without COVID-19. A total of 329,240 patients were included in the study: acute ischemic stroke with COVID-19 (n = 6665, 2.0%) and acute ischemic stroke without COVID-19 (n = 322,575, 98.0%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation, vasopressor use, mechanical thrombectomy, thrombolysis, seizure, acute venous thromboembolism, acute myocardial infarction, cardiac arrest, septic shock, acute kidney injury requiring hemodialysis, length of stay, mean total hospitalization charge, and disposition. Acute ischemic stroke patients who were COVID-19-positive had significantly increased in-hospital mortality compared to acute ischemic stroke patients without COVID-19 (16.9% vs. 4.1%, aOR: 2.5 [95% CI 1.7-3.6], p < 0.001). This cohort also had significantly increased mechanical ventilation use, acute venous thromboembolism, acute myocardial infarction, cardiac arrest, septic shock, acute kidney injury, length of stay, and mean total hospitalization charge. Further research regarding vaccination and therapies will be vital in reducing worse outcomes in patients with acute ischemic stroke and COVID-19.

COVID-19 Associated Myocarditis Clinical Outcomes among Hospitalized Patients in the United States: A Propensity Matched Analysis of National Inpatient Sample

Coronavirus-19 (COVID-19), preliminarily a respiratory virus, can affect multiple organs, including the heart. Myocarditis is a well-known complication among COVID-19 infections, with limited large-scale studies evaluating outcomes associated with COVID-19-related Myocarditis. We used the National Inpatient Sample (NIS) database to compare COVID-19 patients with and without Myocarditis. A total of 1,659,040 patients were included in the study: COVID-19 with Myocarditis (n = 6,455, 0.4%) and COVID-19 without Myocarditis (n = 1,652,585, 99.6%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation, vasopressor use, sudden cardiac arrest, cardiogenic shock, acute kidney injury requiring hemodialysis, length of stay, health care utilization costs, and disposition. We conducted a secondary analysis with propensity matching to confirm results obtained by traditional multivariate analysis. COVID-19 patients with Myocarditis had significantly higher in-hospital mortality compared to COVID-19 patients without Myocarditis (30.5% vs. 13.1%, adjusted OR: 3 [95% CI 2.1-4.2], p < 0.001). This cohort also had significantly increased cardiogenic shock, acute kidney injury requiring hemodialysis, sudden cardiac death, required more mechanical ventilation and vasopressor support and higher hospitalization cost. Vaccination and more research for treatment strategies will be critical for reducing worse outcomes in patients with COVID-19-related Myocarditis.