Retrospective analysis of anti-inflammatory therapies during the first wave of COVID-19 at a community hospital

doi:10.5492/wjccm.v10.i5.244

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 10, Issue 5

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (7115)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-2) series, Tables (1-8) series.

Item

Count

PDF

284

WORD

140

HTML

3788

Figures (1-2)

165

Tables (1-8)

211

Sum=4588

Featured Article

The chart showing Browse series, Download series.

Item

Count

Browse

337

Download

794

Sum=1131

Publishing Process of This Article

Item

Count

Browse

427

Download

969

Sum=1396

Sep 9, 2021 (publication date) through Nov 24, 2024

Times Cited of This Article

Times Cited (2)

Journal Information of This Article

Publication Name

World Journal of Critical Care Medicine

ISSN

2220-3141

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Crit Care Med. Sep 9, 2021; 10(5): 244-259
Published online Sep 9, 2021. doi: 10.5492/wjccm.v10.i5.244

Table 1 Coronavirus disease 2019 patients admitted to intensive care unit characteristics of survivors and non-survivors, n (%)

	Non-survivor (n = 167)	Survivor (n = 94)	P value	OR	95%CI
Age	71 (61, 82)	61 (62, 78)	0.011
Race (Caucasian)	89 (75)	40 (56)	0.007	2.37	1.27-4.40
BMI	29 (23, 34)	28 (24, 32)	0.49
Sex (male)	75 (70)	83 (53)	0.01	0.49	0.29-0.84
Diabetes	31 (29)	53 (34)	0.3	1.26	0.75-2.2
CHF	13 (12)	21 (14)	0.7	1.1	0.66 – 2.4
CAD	24 (29)	41 (27)	0.41	1.2	0.7-2.2
COPD	38 (23)	23 (30)	0.75	0.9	0.5-1.6
CKD	11 (10)	21 (17)	0.1	1.85	0.87-3.83
HTN	54 (51)	91 (59)	0.16	1.4	0.86-2.3
AKI	87 (52)	30 (32)	0.002	2.3	1.21-2.5
Mechanical ventilation	134 (80)	44 (47)	< 0.001	4.7	2.7-8.3
Hemodialysis	29 (18)	10 (11)	0.13	1.8	0.3-3.9
Neutrophils × 10⁹/L	7.3 (4, 10)	7.8 (5.1, 13)	0.97
Lymphocytes	0.7 (0.5, 1.2)	0.9 (0.6, 1.6)	0.011
Neutrophil/lymphocyte	10 (6, 18)	7.5 (4, 14)	0.017
SCr (mg/dL)	1.2 (0.9, 1.9)	1.2 (0.8, 1.8)	0.49
Plts (× 10⁹/L)	230 (162, 310)	236 (182, 302)	0.27
Tbili (mg/dL)	0.5 (0.4, 0.8)	0.5 (0.4, 0.8)	0.65
SOFA admit	5 (3, 9)	4 (2, 6)	0.095
PaO₂/FIO₂	190 (76, 285)	232 (123, 307)	0.039
PaO₂	68 (52, 116)	66 (48-112)	0.083
FIO2	1 (0.45, 1)	1 (0.96, 1)	0.12

OR: Odds ratio; CI: Confidence interval; CAD: Coronary artery disease; COPD: Chronic obstructive pulmonary disease; CKD: Chronic kidney disease; CHF: Congestive heart failure; AKI: Acute kidney injury; HD: Hemodialysis; tBili: Total bilirubin; Plts: Platelets INR: International normalized ratio. PaO₂/FiO₂: Partial pressure of oxygen/inspired concentration of oxygen ratio; SOFA: Sequential Organ Failure Assessment; BMI: Body mass index; SCr: Serum creatinine.

Table 2 Pharmacologic and therapeutic interventions in coronavirus disease 2019 intensive care unit patients, n (%)

	Non-survivor (n = 167)	Survivor (n = 94)	P value	OR	95%CI
GC (all patients)¹	99 (59)	68 (72)	0.035	0.55	0.32-0.96
Vasopressors	124 (74)	35 (37)	< 0.001	4.8	2.8-8.4
IV Ascorbic acid	100 (59)	54 (57)	0.7	1.1	0.66-1.84
Hydroxychloroquine	128 (78)	69 (75)	0.57	1.2	0.65-2.1
Azithromycin	65 (40)	25 (26)	0.06	1.69	0.97-2.9
Heparin therapeutic dose	80 (48)	51 (54)	0.32	0.77	0.46-1.3
Heparin prophylaxis dose	58 (35)	32 (34)	0.91	1.03	0.6-1.75
Convalescent plasma	44 (26)	27 (29)	0.68	0.88	0.5-1.56
Remdesivir	6 (3)	0 (0)
Prone positioning	52 (31)	32 (35)	0.91	1.03	0.6-1.75
Tocilizumab	20 (12)	8 (8.5)	0.55	1.28	0.56-2.9
GC only	44 (26)	29 (30)	0.47	0.8	0.48-1.4
GC + tocilizumab	55 (32)	39 (40)	0.16	0.68	0.4-1.15

¹Treatment stratified as total patients receiving glucocorticoid (GC) therapy (GC alone and GC + tocilizumab).

GC: Glucocorticoid; OR: Odds ratio; CI: Confidence interval; IV: Intravenous.

Table 3 Univariate Cox proportional hazards survival analysis of pharmacological and therapeutic interventions in coronavirus disease 2019 intensive care unit patients

	B	SE	P value	HR	95%CI
GC (all patients)	-0.84	0.16	< 0.001	0.45	0.38-0.61
Vasopressors	0.039	35	0.027	1.4	1.05-2.1
IV ascorbic acid	0.1	0.15	0.49	1.1	0.91-1.5
Hydroxychloroquine	-0.58	0.36	0.1	0.56	0.27-1.14
Azithromycin	0.25	28	0.39	1.3	0.72-2.3
Heparin therapeutic dose	0.15	0.35	0.67	1.16	0.51-2.31
Heparin prophylaxis dose	-0.27	0.3	0.35	0.76	0.48-1.3
Convalescent plasma	0.29	1	0.77	1.3	0.72-9.8
Remdesivir	6 (3)	0
Prone positioning	0.36	0.52	0.44	1.43	0.51-1.4
Tocilizumab	-0.48	0.27	0.08	0.61	0.36-1.06
GC only	-0.75	0.21	0.001	0.47	0.18-0.41
GC + tocilizumab	-1.3	0.21	<0.001	0.27	0.4-1.15

HR: Hazard ratio; CI: Confidence interval; GC: Glucocorticoids; IV: Intravenous.

Table 4 Inflammatory markers in coronavirus disease 2019 survivors and non-survivors

	Non-survivors (n = 167)	Survivors (n = 94)	P value
IL-6 day 1 (pg/mL)	112 (70, 137)	100 (70, 135)	0.34
IL-6 day 2	415 (139, 476)	350 (78, 423)	0.016
D-dimer day 1 (ng/mL)	1125 (647, 2434)	991 (513, 2196)	0.04
D-dimer day 2	849 (604, 1210)	1140 (646, 2263)	0.03
CRP day 1 (mg/L)	117 (89, 159)	113 (96, 149)	0.9
CRP day 2	107 (81, 154)	117 (88, 167)	0.62
Ferritin day 1 (ng/mL)	931 (593, 1367)	960 (609, 1395)	0.51
Ferritin day 2	822 (447, 1432)	1053 (712, 2057)	0.05

IL-6: Interleukin 6, CRP: C-reactive protein.

Table 5 Unadjusted Cox proportional hazards analysis of independent predictors of survival in intensive care unit patients with coronavirus disease 2019

	B	SE	P value	HR	95%CI
Age	0.031	0.007	< 0.001	1.032	1.02-1.05
Sex (male)	0.39	0.2	0.046	1.48	1.008-2.2
Vasopressors	0.485	0.2	0.016	1.62	1.095-2.4
GC administration (all patients)¹	-0.61	0.19	0.002	0.54	0.37-0.79

¹Treatment stratified as total patients receiving GC therapy (GC alone and GC + tocilizumab).

HR: Hazard ratio; CI: Confidence interval; GC: Glucocorticoids.

Table 6 Propensity score adjusted Cox proportional hazards analysis of independent predictors of survival in intensive care unit patients with coronavirus disease 2019

	B	SE	P value	HR	95%CI
Age	0.03	0.007	< 0.001	1.031	1.02-1.05
Sex (male)	0.41	0.2	0.038	1.51	1.022-2.22
Vasopressors	0.47	0.23	0.019	1.6	1.081-2.37
GC + Tocilizumab	-0.78	0.22	0.001	0.46	0.29-0.72
GC only	-0.44	0.22	0.048	0.65	0.42-0.99

SE: Standard error; HR: Hazard ratio; CI: Confidence interval; GC: Glucocorticoids; IV: Intravenous.

Table 7 Propensity score adjusted (glucocorticoids as a time-adjusted covariate) Cox proportional hazards analysis of independent predictors of survival in intensive care unit patients with coronavirus disease 2019

	B	SE	P value	HR	95%CI
Time adjusted GC	2.5	1.01	0.014	12.9	1.06-87.5
Age	0.03	0.007	< 0.001	1.03	1.01-1.04
Sex (male)	0.4	0.2	0.05	1.5	1-2.17
Vasopressors	0.51	0.2	0.01	1.66	1.12-2.4
GC (all patients)¹	-2.94	1.01	0.004	0.05	0.007-0.36

¹Treatment stratified as total patients receiving glucocorticoids (GC) therapy (GC alone and GC + tocilizumab).

SE: Standard error; HR: Hazard ratio; CI: Confidence interval; GC: Glucocorticoids.

Table 8 Propensity score adjusted (glucocorticoids as a time adjusted covariate) Cox proportional hazards analysis of independent predictors of survival in intensive care unit patients with all treatment groups added into the model

	B	SE	P value	HR	95%CI
Time adjusted GC	2.5	1.01	0.015	12	1.62-85
Age	0.03	0.007	< 0.001	1.03	1.01-1.04
Sex (male)	0.4	0.2	0.04	1.5	1.01-2.2
Vasopressors	0.5	0.2	0.01	1.66	1.12-2.45
GC + tocilizumab	-3.07	1.02	0.003	0.046	0.006-0.46
GC (only)	-2.77	1.02	0.007	0.06	0.008-0.46

SE: Standard error; HR: Hazard ratio; CI: Confidence interval; GC: Glucocorticoids.

Citation: Iglesias JI, Vassallo AV, Sullivan JB, Elbaga Y, Patel VV, Patel N, Ayad L, Benson P, Pittiglio M, Gobran E, Clark A, Khan W, Damalas K, Mohan R, Singh SP. Retrospective analysis of anti-inflammatory therapies during the first wave of COVID-19 at a community hospital. World J Crit Care Med 2021; 10(5): 244-259
URL: https://www.wjgnet.com/2220-3141/full/v10/i5/244.htm
DOI: https://dx.doi.org/10.5492/wjccm.v10.i5.244