Title : Clinical outcomes of different treatment approaches under compassionate use among patients with moderate to severe COVID-19 pneumonia admitted in a private tertiary hospital
Abstract:
Background:
The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS Cov-2) is a major global public health and socioeconomic crisis. Patients may present with mild symptoms to severe respiratory distress causing major impact in morbidity and mortality. While treatment is primarily supportive and respiratory management, progression to severe pneumonia compelled the compassionate use of repurposed drugs such as Remdesivir, Hydroxychloroquine, LopinavirRitonavir, Tocilizumab, and non-pharmacologic interventions like Convalescent plasma and Hemoperfusion. Indeed, there are still knowledge gaps regarding clinical data and outcomes with these interventions especially in our country.
Objectives:
To determine the hospital outcomes of the different therapeutic approaches under compassionate use among patients admitted with moderate to severe COVID-19 in a tertiary hospital, to describe the demographic and clinical profiles of patients and to correlate specific biomarkers to clinical presentation and outcomes of patients admitted with COVID-19 disease.
Methods:
A Retrospective Descriptive Analytical Study was done using chart review from Records Section of Adventist Medical Center Manila from March 2020 to December 2021. Mean and standard variations were used in clinical and laboratory parameters. Spearman rho or Fisher’s exact test were used to determine association to clinical status.
Results:
A total of 286 patients were included in this study. Majority of patients were males (64%), ³61 years-old (54.5%), hypertensive (58%) and Remdesivir group (n=187)(65%). Overall, 242 patients (85%) were discharged. Mortality rate was highest among Remdesivir + Tocilizumab + Hemoperfusion group (57%). Mean length of hospital stay was 8 days. Mean days with use of high flow nasal cannula and mechanical ventilator were 3 days and 7 days respectively. There was no significant difference in duration of high flow nasal cannula (p-value=.62) and mechanical ventilation (p-value=.62) use. There was significant decrease in hospital stay with tocilizumab and hemoperfusion (p-value=.001). There was a significant relationship between sPO2, LDH, and CRP to the clinical presentation and hospital outcomes.
Conclusion:
This study revealed that patients with moderate to severe COVID-19, were mostly male, elderly, hypertensive and mortality rate of 15%. Highest mortality rate seen in Remdesivir + Tocilizumab + Hemoperfusion, and lowest among Remdesivir alone. Regardless of the treatment, improvement of oxygenation decreased during subsequent hospital stay. This study found no significant difference in duration of use of high flow nasal cannula and mechanical ventilation between treatment groups. There was significant difference in hospital stay, but does not imply reduced time to recovery as some patients stayed for isolation. Additionally, there was significant correlation between level of laboratory biomarkers to poorer prognosis.
Audience take away:
1. The audience may be able to learn the clinical and demographic profiles of COVID-19 disease in the Philippines. 2. The audience may be able to learn correlation of biomarkers to clinical presentation and outcomes.
3. The audience may be able to learn the clinical outcomes of the different therapeutic approaches under compassionate use
4. This can be used for further investigation of differences in treatment efficacies across these treatment spectrums to with bigger sample.
