Co-relation between high resolution computerised tomography (HRCT) score and effectiveness of remdesivir treatment in covid-19 positive pregnant patients

Abstract

To evaluate the effectiveness of Remdesivir in COVID-19 POSITIVE PREGNANT patients & its co-relation with their HRCT score (with abdominal lead shield) at the time of admission at our institute. It was a retrospective observational study including 93 COVID -19 POSITIVE pregnant patients at varied weeks of gestation admitted and treated at our institute from March 2020 till June 2021. Out of these 15 patients required INTENSIVE CARE UNIT (ICU) admission due to their disease severity and received Remdesivir after physician consultation. Remaining 78 patients had HRCT SCORE of 7 or less (MILD CATEGORY) and did not require ICU admission and hence were excluded from receiving remdesivir.They were divided into 2 groups – Group A and Group B. Group A (MODERATE CATEGORY) including covid -19 positive pregnant patients with HRCT score of 8 to <17/25 had 8 patients and Group B (SEVERE CATEGORY) including covid -19 positive pregnant patients with high HRCT Score of >17/25 had 7 patients. The primary outcome was to evaluate difference in both groups for clinical improvement after 5 days of initiation of Remdisivir therapy in terms of (a) Oxygen requirement (b) Spo2 levels (c) length of hospital stay (d) Death rate (e) HRCT score on day 10 after initiation of remdesivir therapy. Secondary outcome was to evaluate side effects of the drug on the mother and its effect on the baby while in-utero and after delivery. Covid-19 positive pregnant patients with HRCT Score of 8 to <17/25(Group A) showed good prognosis & recovery with rapid decline in Oxygen requirements & improving Spo2 levels after initiation of Remdesivir. They had significantly lower duration of hospital stay (Mean stay of 10.4 + 2.1 days, p < 0.05) and significantly lower death rates (0%, p < 0.05) compared to Group B. Whereas covid -19 positive pregnant patients with high HRCT Score of >17/25 (Group B) did not respond even to prolonged Remdesivir therapy (10 days) and had significantly longer hospital stay (26 + 5.6 days, p <0.05) with significantly higher death rate (42.86% , p<0.05). Patients tolerated Remdesivir well without any side effects. Patients delivered healthy babies with no signs of respiratory illness or any untoward side effects on the baby due to use of Remdesivir. Early referral of COVID -19 positive pregnant patient to hospital when lung lesions are still mild to moderate can be effectively treated with Remdesivir. But severe Covid -19 infection in pregnancy with rampant and excessive ground glass opacities on HRCT at the time of admission is difficult to treat and may not respond to Remdesivir therapy.