Composite Interventions on Outcomes of Severely and Critically Ill Patients with COVID-19 in Shanghai, China

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Jiasheng Shao - (Author)
  • Rong Fan - , Chair of Applied Genomics, Tulane University (Author)
  • Chengnan Guo - (Author)
  • Xuyuan Huang - (Author)
  • Runsheng Guo - (Author)
  • Fengdi Zhang - (Author)
  • Jianrong Hu - (Author)
  • Gang Huang - (Author)
  • Liou Cao - (Author)

Abstract

Background: The sixty-day effects of initial composite interventions for the treatment of severely and critically ill patients with COVID-19 are not fully assessed. Methods: Using a Bayesian piecewise exponential model, we analyzed the 60-day mortality, health-related quality of life (HRQoL), and disability in 1082 severely and critically ill patients with COVID-19 between 8 December 2022 and 9 February 2023 in Shanghai, China. The final 60-day follow-up was completed on 10 April 2023. Results: Among 1082 patients (mean age, 78.0 years, 421 [38.9%] women), 139 patients (12.9%) died within 60 days. Azvudine had a 99.8% probability of improving 2-month survival (adjusted HR, 0.44 [95% credible interval, 0.24–0.79]), and Paxlovid had a 91.9% probability of improving 2-month survival (adjusted HR, 0.71 [95% credible interval, 0.44–1.14]) compared with the control. IL-6 receptor antagonist, baricitinib and a-thymosin each had a high probability of benefit (99.5%, 99.4%, and 97.5%, respectively) compared to their controls, while the probability of trail-defined statistical futility (HR > 0.83) was high for therapeutic anticoagulation (99.8%; HR, 1.64 [95% CrI, 1.06–2.50]) and glucocorticoid (91.4%; HR, 1.20 [95% CrI, 0.71–2.16]). Paxlovid, Azvudine, and therapeutic anticoagulation showed a significant reduction in disability (p < 0.05) Conclusions: Among severely and critically ill patients with COVID-19 who received 1 or more therapeutic interventions, treatment with Azvudine had a high probability of improved 60-day mortality compared with the control, indicating its potential in a resource-limited scenario. Treatment with an IL-6 receptor antagonist, baricitinib, and a-thymosin also had high probabilities of benefit in improving 2-month survival, among which a-thymosin could improve HRQoL. Treatment with Paxlovid, Azvudine, and therapeutic anticoagulation could significantly reduce disability at day 60.

Details

Original languageEnglish
Article number1859
Number of pages17
JournalMicroorganisms
Volume11 (2023)
Issue number7
Publication statusPublished - 23 Jul 2023
Peer-reviewedYes

External IDs

Scopus 85166304399

Keywords