Use of hydroxychloroquine in hospitalised COVID-19 patients is associated with reduced mortality: Findings from the observational multicentre Italian CORIST study
Use of hydroxychloroquine in hospitalised COVID-19 patients is associated with reduced mortality: Findings from the observational multicentre Italian CORIST study
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DOI：
10.1016/j.ejim.2020.08.019
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发表时间：
2020-12-01
影响因子：
8
通讯作者：
Iacoviello, Licia
中科院分区：
文献类型：
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作者：
Di Castelnuovo, Augusto;Costanzo, Simona;Iacoviello, Licia
背景：羟氯喹（HCQ）被提议作为COVID-19的潜在治疗药物。目的：我们建立了一个多中心的意大利合作，以调查HCQ治疗和COVID-19住院死亡率之间的关系。方法：在一项回顾性观察性研究中，分析了2020年2月19日至2020年5月23日期间在意大利33个临床中心住院的3，451例实验室确诊的SARS-CoV-2感染的SARS患者。事件发生时间分析的主要终点是院内死亡，比较了接受HCQ治疗的患者和未接受HCQ治疗的患者。我们使用了多变量考克斯比例风险回归模型，其中通过倾向评分进行治疗加权的逆概率，并添加了亚组分析。结果：在3,451名COVID-19患者中，76.3%接受了HCQ。接受或未接受HCQ的患者的死亡率（每1，000人-天）分别为8.9和15.7。调整倾向评分后，我们发现接受HCQ治疗的患者死亡风险降低30%（HR= 0.70; 95%CI：0.59 - 0.84; E值=1.67）。二次分析得出了相似的结果。HCQ与住院死亡率的负相关性在入院时C反应蛋白升高的患者中尤为明显。结论：HCQ的使用与COVID-19住院患者死亡风险降低30%相关。在观察性研究和等待随机对照试验结果的范围内，这些数据并不妨碍在COVID-19住院患者中使用HCQ。
Background: Hydroxychloroquine (HCQ) was proposed as potential treatment for COVID-19. Objective: We set-up a multicenter Italian collaboration to investigate the relationship between HCQ therapy and COVID-19 in-hospital mortality.Methods: In a retrospective observational study, 3,451 unselected patients hospitalized in 33 clinical centers in Italy, from February 19, 2020 to May 23, 2020, with laboratory-confirmed SARS-CoV-2 infection, were analyzed. The primary end-point in a time-to event analysis was in-hospital death, comparing patients who received HCQ with patients who did not. We used multivariable Cox proportional-hazards regression models with inverse probability for treatment weighting by propensity scores, with the addition of subgroup analyses.Results: Out of 3,451 COVID-19 patients, 76.3% received HCQ. Death rates (per 1,000 person-days) for patients receiving or not HCQ were 8.9 and 15.7, respectively. After adjustment for propensity scores, we found 30% lower risk of death in patients receiving HCQ (HR= 0.70; 95%CI: 0.59 to 0.84; E-value=1.67). Secondary analyses yielded similar results. The inverse association of HCQ with inpatient mortality was particularly evident in patients having elevated C-reactive protein at entry.Conclusions: HCQ use was associated with a 30% lower risk of death in COVID-19 hospitalized patients. Within the limits of an observational study and awaiting results from randomized controlled trials, these data do not discourage the use of HCQ in inpatients with COVID-19.