Design: Multinational registry analysis including 671 hospitals in North America, South America, Europe, Africa, Asia, and Australia.
Subjects: Patients hospitalized between Dec 20, 2019, and April 14, 2020, and tested positive for SARS-CoV-2. Data abstracted from Surgical Outcomes Collaborative (Surgisphere Corporation, Chicago, IL, USA) database.
Treatment group: Patients who received either HCQ or CQ either alone or in combination with a macrolide. There were four groups of patients:
Excluded: Patients who received treatment after 48 h of diagnosis of COVID-19; patients who received the study drugs while on mechanical ventilation; patients who were treated with remdesivir.
In-hospital mortality. Overall mortality was 10698 (11·1%) of 96032.
Odds ratios for in-hospital mortality
Cox regression analysis
Increased risk of in-hospital death: Age, BMI, black race or Hispanic ethnicity (versus white race), coronary artery disease, congestive heart failure, history of arrhythmia, diabetes, hypertension, hyperlipidemia, COPD, being a current smoker
Decreased risk of in-hospital death: Female gender, Asian, ACE inhibitors (but not angiotensin receptor blockers), statins
Dysrhythmias: non-sustained (less than 6 seconds) or sustained VT or VF
Patients with coronary artery disease, congestive heart failure, history of cardiac arrhythmia, and COPD had a higher risk of arrhythmias
Odds ratio for arrhythmias
Propensity matching showed that the associations between the drug regimens and mortality, need for mechanical ventilation, length of stay, and the occurrence of de-novo ventricular arrhythmias were consistent with the primary analysis.
A large number of patients – biggest data available to date
Very useful to understand common patterns emerging in COVID-19. i. Morbidly obese male patients with age >60 years with at least one CVS co-morbidity are at high risk for mortality. ii.COPD and immunocompromised patients are somehow not affected contrary to what was hypothesised initially.
Observational study design – lots of confounding factors
Cause-effect relationship between drug therapy and survival should not be interfered.
Baseline QTc was not measured in any of the patient.
Stratification of arrhythmia patterns is not provided.
Study does not include those receiving mechanical ventilation prior to commencement of these drugs.
Very insightful study
Raises the question of further need of RCT for macrolide and HCQ. However, prophylaxis use of HCQ is still debatable.
HCQ and macrolide should not be prescribed to COVID-19 patients.
Tracheostomy – Tracheotomy in ventilated patients with COVID-19: Guidelines from the COVID-19 Tracheotomy Task Force, a Working Group of the Airway SafetyCommittee of the University of Pennsylvania Health System, published […]