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Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study

Boari et al., Biosci. Rep., doi:10.1042/BSR20203455

Nov 2020

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HCQ for COVID-19

1st treatment shown to reduce risk in March 2020

^*, now known with p < 0.00000000001 from 422 studies, recognized in 42 countries.

Lower risk for mortality, hospitalization, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine complementary and synergistic treatments. ^* >10% efficacy in meta analysis with ≥3 clinical studies.

4,000+ studies for 60+ treatments. c19hcq.org

Retrospective 258 hospitalized patients in Italy showing lower mortality with HCQ treatment, unadjusted relative risk RR 0.455, p<0.001. Data is in the supplementary appendix.

This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.

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risk of death, 54.5% lower, RR 0.45, p < 0.001, treatment 41 of 202 (20.3%), control 25 of 56 (44.6%), NNT 4.1.

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Boari et al., 17 Nov 2020, retrospective, Italy, peer-reviewed, 20 authors.

This Paper HCQ All

Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study

Gianluca E M Boari, Giulia Chiarini, Silvia Bonetti, Paolo Malerba, Gianluca Bianco, Cristina Faustini, Federico Braglia-Orlandini, Daniele Turini, Vittoria Guarinoni, Michele Saottini, Sara Viola, Giulia Ferrari-Toninelli, Giancarlo Pasini, Cristina Mascadri, Bianca Bonzi, Paolo Desenzani, Claudia Tusi, Eros Zanotti, Matteo Nardin, Damiano Rizzoni

Bioscience Reports, doi:10.1042/bsr20203455

The aim of the present study was to simultaneously assess several potential predictors of outcome (co-morbidity, previous and in-hospital treatment, radiologic Brixia score) in patients with COVID-19. This retrospective cohort study included 258 consecutive patients with confirmed COVID-19 admitted to a medical ward at Montichiari Hospital, Brescia, Italy from February 28th to April 30rd, 2020. Patients had SARS-CoV-2 related pneumonia with respiratory failure, and were treated with hydroxychloroquine and lopinavir plus ritonavir. In some patients, additional treatment with tocilizumab, dexamethasone and enoxaparin was adopted. Outcomes (death or recovery) were assessed at the end of the discharge period or at the end of the follow-up (August 2020). During hospitalization, 59 patients died, while 6 died after discharge. The following variables were demonstrated to be associated with a worse prognosis: Radiologic Brixia score higher than 8, presence at baseline of hypertension, diabetes, chronic obstructive pulmonary disease, heart disease, cancer, previous treatment with ACE-inhibitors or anti-platelet drugs. Anticoagulant treatment during hospital admission with enoxaparin at a dose higher than 4000 U once daily was associated with a better prognosis. In conclusion, our study demonstrates that some co-morbidities and cardiovascular risk factors may affect prognosis. The radiologic Brixia score may be a useful tool to stratify the risk of death at baseline. Anticoagulant treatment with enoxaparin might be associated to a clinical benefit in terms of survival in patients with COVID-19.

Competing Interests The authors declare that there are no competing interests associated with the manuscript. Author Contribution Gianluca E.M. Boari Design, data analysis and graphics. Giulia Chiarini Data collection. Silvia Bonetti Data collection. Paolo Malerba Data collection. Gianluca Bianco Data collection. Cristina Faustini Data collection. Federico Braglia-Orlandini Data collection. Daniele Turini, Data collection. Vittoria Guarinoni, Clinical handling of patients and data collection. Michele Saottini, Clinical handling of patients and data collection. Sara Viola, Clinical handling of patients and data collection. Giulia Ferrari-Toninelli, Clinical handling of patients and data collection. Giancarlo Pasini, Clinical handling of patients and data collection. Cristina Mascadri Abbreviations γGT, gamma glutamyl transferase; ALT, alanine aminotransferase; aPTT, activated partial thromboplastin time; ARDS, acute respiratory distress syndrome; AST, aspartate aminotransferase; CRP, c-reactive protein; INR, international normalized ratio.

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