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：
10.1101/2020.04.16.20065920
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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：尽管证据有限且相互矛盾，羟氯喹单独或与阿奇霉素联合使用，广泛用于 COVID-19 治疗。方法：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确诊感染 SARS-CoV-2 的住院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单独接触羟氯喹的情况进行分类(HC) 或用阿奇霉素 (HC+AZ) 或无 HC 治疗。主要结局是死亡率和机械通气的使用。结果：总共对 807 名患者进行了评估。与无 HC 组相比，根据临床特征进行倾向评分调整后，HC 组全因死亡风险较高（调整后风险比 [aHR]，1.83；95% 置信区间 [CI]，1.16-2.89；p = 0.009），但 HC+AZ 组则不然（aHR，1.31；95% CI，0.80-2.15；p = 0.28）。在 HC 组（分别为 aHR，1.19；95% CI，0.78-1.82；p = 0.42；aHR，2.11；95% CI，0.96-4.62；p = 0.06）和 HC+AZ 组（aHR，与无 HC 组相比，1.09；95% CI，0.72-1.66；aHR，1.25；95% CI，0.59-2.68；p = 0.56。结论：在住院的 COVID-19 患者中，使用或没有阿奇霉素。
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.