Details

Autor(en) / Beteiligte

• Valerio Pascua, Fernando
• Diaz, Oscar
• Medina, Rina
• Contreras, Brian
• Mistroff, Jeff
• Espinosa, Daniel
• Sekhon, Anupamjeet
• Paz Handal, Diego
• Pineda, Estela
• Vargas Pineda, Miguel
• Pineda, Hector
• Diaz, Maribel
• Lewis, Anita S
• Hesse, Heike
• Castro Lainez, Miriams T
• Stevens, Mark L
• Sierra-Hoffman, Miguel
• Ontai, Sidney C
• VanBuren, Vincent
• Kou, Yu Ru

Titel

A multi-mechanism approach reduces length of stay in the ICU for severe COVID-19 patients

Ist Teil von

• PloS one, 2021-01, Vol.16 (1), p.e0245025-e0245025

Ort / Verlag

United States: Public Library of Science

Erscheinungsjahr

2021

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• COVID-19 pandemic has multifaceted presentations with rising evidence of immune-mediated mechanisms underplay. We sought to explore the outcomes of severe COVID-19 patients treated with a multi-mechanism approach (MMA) in addition to standard-of-care (SC) versus patients who only received SC treatment. Data were collected retrospectively for patients admitted to the intensive care unit (ICU). This observational cohort study was performed at five institutions, 3 in the United States and 2 in Honduras. Patients were stratified for MMA vs. SC treatment during ICU stay. MMA treatment consists of widely available medications started immediately upon hospitalization. These interventions target immunomodulation, anticoagulation, viral suppression, and oxygenation. Primary outcomes included in-hospital mortality and length of stay (LOS) for the index hospitalization and were measured using logistic regression. Of 86 patients admitted, 65 (76%) who had severe COVID-19 were included in the study; 30 (46%) patients were in SC group, compared with 35 (54%) patients treated with MMA group. Twelve (40%) patients in the SC group died, compared with 5 (14%) in the MMA group (p-value = 0.01, Chi squared test). After adjustment for gender, age, treatment group, Q-SOFA score, the MMA group had a mean length of stay 8.15 days, when compared with SC group with 13.55 days. ICU length of stay was reduced by a mean of 5.4 days (adjusted for a mean age of 54 years, p-value 0.03) and up to 9 days (unadjusted for mean age), with no significant reduction in overall adjusted mortality rate, where the strongest predictor of mortality was the use of mechanical ventilation. The finding that MMA decreases the average ICU length of stay by 5.4 days and up to 9 days in older patients suggests that implementation of this treatment protocol could allow a healthcare system to manage 60% more COVID-19 patients with the same number of ICU beds.