Comparison of the intensive care unit admission rate and mortalities of COVID-19 patients who received hydroxychloroquine and eavipiravir in the ward

Abstract

Background: Until now, a fully accepted treatment method for the management of COVID-19 has not been recommended. Some antiviral drugs such favipiravir and remdesivir, antimalarial drugs like hydroxychloroquine and anti-inflammatory drugs have been used for the treatment of the patients with COVID-19. The aim of this retrospective study is to compare the Intensive Care Unit (ICU) admission rate and mortalities of COVID-19 patients who received Hydroxychloroquine and Favipiravir in the COVID positive wards. Methods: First approval was obtained from the ethics committee, then the patients with COVID-19 who were under follow-up and treat in the COVID positive wards between March and December 2020 were retrospectively analyzed. We aimed to investigate the demographic characteristics, the reason for hospitalization, Charlson comorbidity index, hemodynamic and laboratory parameters, duration of the ward, the rate of discharged from the ward, the ward mortality rate, the ICU admission rate, and mortalities of these patients. The patients were divided into two groups as Hydroxychloroquine Group (H Group) and Favipiravir Group (F Group). The patients in the H Group received hydroxychloroquine 400 mg orally 2x/day on day 1, then 200 mg 2x/day on days 2-5. The patients in the F group received favipiravir 1600 mg 2x/day on day 1, then 600 mg 2x/day on days 2-5. Decreased oxygen saturation and PaO2/FiO2 rate, increased respiration rate with worsening clinical condition and elevated inflammatory parameters such CRP, ferritin, D-dimer, creatinine, lactate and troponin were accepted as criteria for admission to ICU. Demographic and clinical characteristics, and the ICU admission rate, the discharge from the ward and mortalities were compared between the two groups. Results: A total of 2734 patients were analyzed retrospectively and divided into H and F groups. The main reasons for hospitalization were fatigue, shortness of breath, fever, low oxygen saturation and positive PCR test with positive chest computerized tomography findings for COVID-19 in all patients. Age, gender, Body Mass Index (BMI), Charlson Comorbidity Index (CCI), mean blood pressure, heart rate, respiratory rate and oxygen saturation were not significant different between the H and F groups at admission. The treatments of the patients in the wards such the support of oxygen with reservoir mask, enoxaparin as an anticoagulant, acetylcysteine to loss mucus in the airways, steroid use, vitamin C and D, and patient’s nutrition were the same. The ICU admission criteria were similar between the two groups. The rate of discharged from the ward was significantly higher in the H group when compared with F group as 85,75% versus 73,74%. In addition, the ICU admission rate was significantly lower in the H group than F group as 9,79% versus 20,54%. The ward mortality and ICU mortality rates were not significant different between the two groups. However, total mortality rate, considering of the total ward and ICU, was significantly lower in The H group. Conclusion: This retrospective study showed that hydroxychloroquine lowers the ICU admission rate and raises the discharge rate when compared with favipiravir in the ward patients with COVID-19. However, it does not change the ward and the ICU mortality rates.