Outcomes of Hydroxychloroquine Usage in United States Veterans Hospitalized with COVID-19
Outcomes of Hydroxychloroquine Usage in United States Veterans Hospitalized with COVID-19
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DOI：
10.1016/j.medj.2020.06.001
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发表时间：
2020-12-18
期刊：
影响因子：
17
通讯作者：
Ambati, Jayakrishna
中科院分区：
文献类型：
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作者：
Magagnoli, Joseph;Narendran, Siddharth;Ambati, Jayakrishna
背景资料：尽管证据有限且相互矛盾，但羟氯喹单独或与阿奇霉素联合广泛用于COVID-19 therapy.Methods：我们对2020年3月9日至2020年4月29日期间在美国退伍军人健康管理局医疗中心因确诊SARS-CoV-2感染住院的患者的电子健康记录进行了回顾性研究。诊断后24小时内住院的患者根据其暴露于羟氯喹（HC）或阿奇霉素（HC+AZ）或无HC治疗进行分类。主要结果是死亡率和机械通气的使用。结果：共807例患者进行了评价。与无HC组相比，在对临床特征进行倾向评分调整后，HC组中任何原因导致的死亡风险更高（校正的风险比[aHR]，1.83; 95%置信区间[CI]，1.16-2.89; p = 0.009），但HC+AZ组未发生（aHR，1.31; 95% CI，0.80-2.15; p = 0.28）。HC组的机械通气和机械通气后死亡的倾向评分校正风险均无显著差异（aHR，1.19; 95% CI，0.78-1.82; p = 0.42和aHR，2.11; 95% CI，0.96-4.62; p = 0.06）或HC+AZ组（aHR，1.09; 95% CI，0.72-1.66; p = 0.69和aHR，1.25; 95% CI，0.59-2.68; p = 0.56）。在因COVID-19住院的患者中，这项回顾性研究没有发现使用或不使用阿奇霉素的羟氯喹治疗在死亡率或机械通气需求方面有任何显著降低。
Background: Despite limited and conflicting evidence, hydroxychloroquine, alone or in combination with azithromycin, is widely used in COVID-19 therapy.Methods: We performed a retrospective study of electronic health records of patients hospitalized with confirmed SARS-CoV-2 infection in US Veterans Health Administration medical centers between March 9, 2020 and April 29, 2020. Patients hospitalized within 24 h of diagnosis were classified based on their exposure to hydroxychloroquine alone (HC) or with azithromycin (HC+AZ) or no HC as treatments. The primary outcomes were mortality and use of mechanical ventilation.Findings: A total of 807 patients were evaluated. Compared to the no HC group, after propensity score adjustment for clinical characteristics, the risk of death from any cause was higher in the HC group (adjusted hazard ratio [aHR], 1.83; 95% confidence interval [CI], 1.16-2.89; p = 0.009), but not in the HC+AZ group (aHR, 1.31; 95% CI, 0.80-2.15; p = 0.28). Both the propensity-score-adjusted risks of mechanical ventilation and death after mechanical ventilation were not significantly different in the HC group (aHR, 1.19; 95% CI, 0.78-1.82; p = 0.42 and aHR, 2.11; 95% CI, 0.96-4.62; p = 0.06, respectively) or in the HC+AZ group (aHR, 1.09; 95% CI, 0.72-1.66; p = 0.69 and aHR, 1.25; 95% CI, 0.59-2.68; p = 0.56, respectively) compared to the no HC group.Conclusions: Among patients hospitalized with COVID-19, this retrospective study did not identify any significant reduction in mortality or in the need for mechanical ventilation with hydroxychloroquine treatment with or without azithromycin.