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Topics in Antiviral Medicine ; 30(1 SUPPL):250, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1880741


Background: The World Health Organization (WHO) ordinal scale (OS) is used to evaluate participant outcomes in clinical trials. We modified the WHO OS to enable assessment of patient outcomes associated with various treatment agents using the National COVID Cohort Collaborative (N3C), a national database containing electronic Health Record (EHR) data from > 2.7 million persons with a COVID-19 diagnosis from > 55 U.S. sites. Methods: Modified OS severity scores (Table 1) were assigned in the first through fourth weeks following COVID-19 diagnosis for a sample of patients in N3C. To adjust for disease severity at patient hospitalization, we developed separate models to examine OS levels of 3, 5, 7, and 9. Elastic net penalized multinomial logistic regression was used to simultaneously identify risk factors and predict the probability of each level of the ordinal scale at week 4. We studied groups of anticoagulants (AC), steroids, antibiotics, antiviral agents (AA), monoclonal antibodies (MA), and a miscellaneous group that included all other treatments. Other factors considered were presence of comorbid conditions using the Charlson Comorbidity Index (CCI), ethnicity, age, gender, and time of diagnosis (by quarter). Results: We included 1,489,191 COVID-19 (161,385 outpatients were excluded) patients. Patient characteristics and treatment approaches applied to each OS level were analyzed (Table 1). For hospitalized patients with a Week 1 OS score of 3,5,7, or 9, we found that increased CCI values are associated with higher probabilities of a worsened OS score at Week 4. Given that MAs are a standard treatment for patients at OS levels 3 and 5, and that steroids are typically used at OS 7 and 9, we studied treatment combinations related to MA and steroids given during Week 1. Improved outcomes by Week 4 were demonstrated with AA+MA for OS 3 and for AC+MA for OS 5 (Table 1). Patients at OS 7 in Week 1 had improved Week 4 outcomes with steroids alone while OS 7 patients with CCI>10 had better outcomes with steroids+AC. OS 9 patients treated with steroids+MA had better outcomes compared with those not given that combination. Conclusion: Our analyses identify relationships between COVID-19 serverity, specific treatments and outcomes at 4 weeks after diagnosis. Use of MA at lower levels of severity, and steroids at higher severity levels were associated with survival to hospital discharge.