Abstract
BackgroundCOVID-19 pandemic is the major public health problem in the world actually. It’s associated with high morbidity and mortality. To date, no therapeutic measure has a curative potential. Hydroxychloroquine (HCQ) is a drug with immunomodulatory properties that has demonstrated antiviral efficacy in in vitro experiments, with conflicting results in in vivo studies.MethodsA single-center, prospective and interventional study, that evaluates the impact on mortality of the HCQ use in 154 patients hospitalized with COVID-19 in a Brazilian public hospital. The study also aims to determine prognostic factors that predict mortality, ICU admission and endotracheal intubation in this population.Results154 patients diagnosed with COVID-19 confirmed by RT-PCR and hospitalized were included. There was a male predominance (87/154, 56.5%), median age 60 years and 88% (136/154) had comorbidities. Among these, 76% (117/154) were admitted to the ICU and 29.2% (45/154) experienced EOT. The OMR was 51.3% (79/154). There was no difference in mortality between patients treated with HCQ (N = 95) and non-HCQ (N = 59) (44.1% × 55.8%, p = 0.758). In univariate analysis, age ≥ 60 years (HR 3.62, p < 0.001), need for mechanical ventilation (HR 2.17, p = 0.001), ≥ 2 comorbidities (HR 1.83, p = 0.049), SAH (HR: 1.56, p = 0.054) were predictors of mortality, as well as no use of prophylactic or therapeutic heparin (HR 3.60, p = 0.02). Multivariate analysis identified admission to the ICU (HR 8.98, p = 0.002) and advanced age (HR 3.37, p < 0.01) as independent predictors of mortality, although, use of heparin (HR 0.25, p = 0.001) was independently associated with a favorable outcome.ConclusionThis study confirmed the absence of a benefit associated with the use of HCQ in Brazilian patients hospitalized with COVID-19. However, prophylactic or therapeutic heparin was an independent predictor for reducing mortality in this population.
Highlights
More than one year ago, in December 2019, an outbreak caused a respiratory illness in Wuhan, China, caused by a novel coronavirus and later named Coronavirus disease 2019 (COVID-19) [1]
This study confirmed the absence of a benefit associated with the use of HCQ in Brazilian patients hospitalized with COVID-19
Prophylactic or therapeutic heparin was an independent predictor for reducing mortality in this population
Summary
More than one year ago, in December 2019, an outbreak caused a respiratory illness in Wuhan, China, caused by a novel coronavirus (nCov) and later named Coronavirus disease 2019 (COVID-19) [1]. Hydroxychloroquine (HCQ), an aminoquinolone used on the treatment of autoimmune diseases and malaria showed, on a small non-randomized trial, in the beginning of the COVID-19 pandemic, high efficacy with virologic cure when associated with azithromycin (AZTH) [3]. In Brazil, since March 2020, the Ministry of Health made available both Hydroxychloroquine and azithromycin for severe cases, at the discretion of the treating physician [4]. With the first COVID-19 case recorded in Brazil located in São Paulo, considering the threat of the COVID-19 pandemic and with no randomized controlled trials available on timeframe, we performed an unicentric, prospective, interventional and consecutive non-randomized study to assess whether HCQ alone or in combination with azithromycin, would impact on mortality outcomes in hospitalized patients with documented pneumonia for COVID-19 on Public Health System in Brazil. Hydroxychloroquine (HCQ) is a drug with immunomodulatory properties that has demonstrated antiviral efficacy in in vitro experiments, with conflicting results in in vivo studies
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