Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis
Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis
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DOI：
10.1016/j.tmaid.2020.101791
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发表时间：
2020-07-01
影响因子：
12
通讯作者：
Raoult, Didier
中科院分区：
文献类型：
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作者：
Lagier, Jean-Christophe;Million, Matthieu;Raoult, Didier
背景：在我们位于法国马赛的研究所，我们启动了2019年冠状病毒病早期大规模筛查(新冠肺炎)。方法：回顾3737例初治患者的临床治疗情况，其中3119例(83.5%)患者口服羟基氯喹200 mg，每日3次，连续10天，第1天口服AZ 500 mg，随后每天250 mg，连续4天以上，618例(16.5%)接受其他方案治疗。结果：患者平均年龄45岁(SD17)，男性占45%，病死率为0.9%。我们进行了2065次低剂量CT扫描，突出了991名临床症状最轻(新闻评分为0)的患者中的592名(59.7%)的肺部病变。观察到自发性呼吸困难、低氧血症和肺部病变之间的差异。临床因素(年龄、合并症、NEWS-2评分)、生物学因素(淋巴细胞减少、嗜酸性粒细胞减少、血锌降低、D-二聚体、乳酸脱氢酶、肌酸磷酸激酶、肌钙蛋白和C反应蛋白升高)和低剂量CT扫描发现的中、重度病变与较差的临床结果相关。使用HCQ-AZ治疗与转移到ICU或死亡的风险降低(危险比(HR)0.18~0.11-0.27)、住院风险降低(OR=10天)(优势比95%CI 0.38 0.27~0.54)和病毒排出时间缩短(聚合酶链式反应阴性的时间：HR 1.29 1.17~1.42)相关。有25例(0.67%)QT间期延长(>；60ms)导致12例患者停止治疗，其中3例QT>；500ms。结论：虽然这是一个回顾性分析，但结果表明，对新冠肺炎患者进行早诊断、早隔离、早治疗，并使用至少3天的HCQ-AZ治疗，比其他治疗方法更快、更快地减少病毒载量，并显著改善临床预后。
Background: In our institute in Marseille, France, we initiated early and massive screening for coronavirus disease 2019 (COVID-19). Hospitalization and early treatment with hydroxychloroquine and azithromycin (HCQ-AZ) was proposed for the positive cases.Methods: We retrospectively report the clinical management of 3,737 screened patients, including 3,119 (83.5%) treated with HCQ-AZ (200 mg of oral HCQ, three times daily for ten days and 500 mg of oral AZ on day 1 followed by 250 mg daily for the next four days, respectively) for at least three days and 618 (16.5%) patients treated with other regimen ("others"). Outcomes were death, transfer to the intensive care unit (ICU), >= 10 days of hospitalization and viral shedding.Results: The patients' mean age was 45 (sd 17) years, 45% were male, and the case fatality rate was 0.9%. We performed 2,065 low-dose computed tomography (CT) scans highlighting lung lesions in 592 of the 991 (59.7%) patients with minimal clinical symptoms (NEWS score = 0). A discrepancy between spontaneous dyspnoea, hypoxemia and lung lesions was observed. Clinical factors (age, comorbidities, NEWS-2 score), biological factors (lymphocytopenia; eosinopenia; decrease in blood zinc; and increase in D-dimers, lactate dehydrogenase, creatinine phosphokinase, troponin and C-reactive protein) and moderate and severe lesions detected in low-dose CT scans were associated with poor clinical outcome. Treatment with HCQ-AZ was associated with a decreased risk of transfer to ICU or death (Hazard ratio (HR) 0.18 0.11-0.27), decreased risk of hospitalization >= 10 days (odds ratios 95% CI 0.38 0.27-0.54) and shorter duration of viral shedding (time to negative PCR: HR 1.29 1.17-1.42). QTc prolongation (>60 ms) was observed in 25 patients (0.67%) leading to the cessation of treatment in 12 cases including 3 cases with QTc> 500 ms. No cases of torsade de pointe or sudden death were observed.Conclusion: Although this is a retrospective analysis, results suggest that early diagnosis, early isolation and early treatment of COVID-19 patients, with at least 3 days of HCQ-AZ lead to a significantly better clinical outcome and a faster viral load reduction than other treatments.