Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort)

Guisado Vasco, Pablo; Carralón González, María Maravillas; González Cortijo, Lucía; Sotres Fernández, Gabriel; Luque Pinilla, José Manuel; Almagro Casado, Elena; Barrena Puertas, Ruth; Andreu Vázquez, Cristina; Thuissard Vasallo, Israel John; Carnevali Ruiz, Daniel; Et al.

Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort)

Background The COVID-19 outbreak challenges the Spanish health system since March 2020. Some available therapies (antimalarials, antivirals, biological agents) were grounded on clinical case observations or basic science data. The aim of this study is to describe the characteristics and impact of di...

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Detalhes bibliográficos
Autores:	Guisado Vasco, Pablo, Carralón González, María Maravillas, González Cortijo, Lucía, Sotres Fernández, Gabriel, Luque Pinilla, José Manuel, Almagro Casado, Elena, Barrena Puertas, Ruth, Andreu Vázquez, Cristina, Thuissard Vasallo, Israel John, Carnevali Ruiz, Daniel , Et al.
Formato:	artículo
Fecha de publicación:	2020
País:	España
Recursos:	Universidad Europea (UEM)
Repositorio:	ABACUS. Repositorio de Producción Científica
Idioma:	inglés
OAI Identifier:	oai:abacus.universidadeuropea.com:11268/9897
Acesso em linha:	http://hdl.handle.net/11268/9897
Access Level:	acceso abierto
Palavra-chave:	Infecciones por coronavirus Virología Hospital Tratamiento médico

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spelling	Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort)Guisado Vasco, PabloCarralón González, María MaravillasGonzález Cortijo, LucíaSotres Fernández, GabrielLuque Pinilla, José ManuelAlmagro Casado, ElenaBarrena Puertas, RuthAndreu Vázquez, CristinaThuissard Vasallo, Israel JohnCarnevali Ruiz, Daniel Et al.Infecciones por coronavirusVirologíaHospitalTratamiento médicoBackground The COVID-19 outbreak challenges the Spanish health system since March 2020. Some available therapies (antimalarials, antivirals, biological agents) were grounded on clinical case observations or basic science data. The aim of this study is to describe the characteristics and impact of different therapies on clinical outcomes in a cohort of severe COVID-19 patients. Methods In this retrospective, single-center, observational study, we collected sequential data on adult patients admitted to Hospital Universitario Quironsalud Madrid. Eligible patients should have a microbiological (positive test on RT-PCR assay from a nasal swab) or an epidemiological diagnosis of severe COVID-19. Demographic, baseline comorbidities, laboratory data, clinical outcomes, and treatments were compared between survivors and non-survivors. We carried out univariate and multivariate logistic regression models to assess potential risk factors for in-hospital mortality. Findings From March 10th to April 15th, 2020, 607 patients were included. Median age was 69 years [interquartile range, {IQR} 22; 65% male). The most common comorbidities were hypertension (276 [46·94%]), diabetes (95 [16·16%]), chronic cardiac (133 [22·62%]) and respiratory (114 [19·39%]) diseases. 141 patients (23·2%) died. In the multivariate model the risk of death increased with older age (odds ratio, for every year of age, 1·15, [95% CI 1·11 - 1·2]), tocilizumab therapy (2·4, [1·13 - 5·11]), C-reactive protein at admission (1·07, per 10 mg/L, [1·04 - 1·10]), d-dimer > 2·5 μg/mL (1·99, [1·03 - 3·86]), diabetes mellitus (2·61, [1·19 - 5·73]), and the PaO2/FiO2 at admission (0·99, per every 1 mmHg, [0·98 - 0·99]). Among the prescribed therapies (tocilizumab, glucocorticoids, lopinavir/ritonavir, hydroxychloroquine, cyclosporine), only cyclosporine was associated with a significant decrease in mortality (0·24, [0·12 - 0·46]; p<0·001). Interpretation In a real-clinical setting, inhibition of the calcineurin inflammatory pathway, NF-κΒ, could reduce the hyperinflammatory phase in COVID-19. Our findings might entail relevant implications for the therapy of this disease and could boost the design of new clinical trials among subjects affected by severe COVID-19.20212021-03-0920202020-01-0120202020-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/11268/9897reponame:ABACUS. Repositorio de Producción Científicainstname:Universidad Europea (UEM)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:abacus.universidadeuropea.com:11268/98972026-06-11T12:41:27Z
dc.title.none.fl_str_mv	Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort)
title	Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort)
spellingShingle	Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort) Guisado Vasco, Pablo Infecciones por coronavirus Virología Hospital Tratamiento médico
title_short	Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort)
title_full	Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort)
title_fullStr	Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort)
title_full_unstemmed	Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort)
title_sort	Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort)
dc.creator.none.fl_str_mv	Guisado Vasco, Pablo Carralón González, María Maravillas González Cortijo, Lucía Sotres Fernández, Gabriel Luque Pinilla, José Manuel Almagro Casado, Elena Barrena Puertas, Ruth Andreu Vázquez, Cristina Thuissard Vasallo, Israel John Carnevali Ruiz, Daniel Et al.
author	Guisado Vasco, Pablo
author_facet	Guisado Vasco, Pablo Carralón González, María Maravillas González Cortijo, Lucía Sotres Fernández, Gabriel Luque Pinilla, José Manuel Almagro Casado, Elena Barrena Puertas, Ruth Andreu Vázquez, Cristina Thuissard Vasallo, Israel John Carnevali Ruiz, Daniel Et al.
author_role	author
author2	Carralón González, María Maravillas González Cortijo, Lucía Sotres Fernández, Gabriel Luque Pinilla, José Manuel Almagro Casado, Elena Barrena Puertas, Ruth Andreu Vázquez, Cristina Thuissard Vasallo, Israel John Carnevali Ruiz, Daniel Et al.
author2_role	author author author author author author author author author author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv	Infecciones por coronavirus Virología Hospital Tratamiento médico
topic	Infecciones por coronavirus Virología Hospital Tratamiento médico
description	Background The COVID-19 outbreak challenges the Spanish health system since March 2020. Some available therapies (antimalarials, antivirals, biological agents) were grounded on clinical case observations or basic science data. The aim of this study is to describe the characteristics and impact of different therapies on clinical outcomes in a cohort of severe COVID-19 patients. Methods In this retrospective, single-center, observational study, we collected sequential data on adult patients admitted to Hospital Universitario Quironsalud Madrid. Eligible patients should have a microbiological (positive test on RT-PCR assay from a nasal swab) or an epidemiological diagnosis of severe COVID-19. Demographic, baseline comorbidities, laboratory data, clinical outcomes, and treatments were compared between survivors and non-survivors. We carried out univariate and multivariate logistic regression models to assess potential risk factors for in-hospital mortality. Findings From March 10th to April 15th, 2020, 607 patients were included. Median age was 69 years [interquartile range, {IQR} 22; 65% male). The most common comorbidities were hypertension (276 [46·94%]), diabetes (95 [16·16%]), chronic cardiac (133 [22·62%]) and respiratory (114 [19·39%]) diseases. 141 patients (23·2%) died. In the multivariate model the risk of death increased with older age (odds ratio, for every year of age, 1·15, [95% CI 1·11 - 1·2]), tocilizumab therapy (2·4, [1·13 - 5·11]), C-reactive protein at admission (1·07, per 10 mg/L, [1·04 - 1·10]), d-dimer > 2·5 μg/mL (1·99, [1·03 - 3·86]), diabetes mellitus (2·61, [1·19 - 5·73]), and the PaO2/FiO2 at admission (0·99, per every 1 mmHg, [0·98 - 0·99]). Among the prescribed therapies (tocilizumab, glucocorticoids, lopinavir/ritonavir, hydroxychloroquine, cyclosporine), only cyclosporine was associated with a significant decrease in mortality (0·24, [0·12 - 0·46]; p<0·001). Interpretation In a real-clinical setting, inhibition of the calcineurin inflammatory pathway, NF-κΒ, could reduce the hyperinflammatory phase in COVID-19. Our findings might entail relevant implications for the therapy of this disease and could boost the design of new clinical trials among subjects affected by severe COVID-19.
publishDate	2020
dc.date.none.fl_str_mv	2020 2020-01-01 2020 2020-01-01 2021 2021-03-09
dc.type.none.fl_str_mv	journal article http://purl.org/coar/resource_type/c_6501
dc.type.openaire.fl_str_mv	info:eu-repo/semantics/article
format	article
dc.identifier.none.fl_str_mv	http://hdl.handle.net/11268/9897
url	http://hdl.handle.net/11268/9897
dc.language.none.fl_str_mv	Inglés eng
language_invalid_str_mv	Inglés
language	eng
dc.rights.none.fl_str_mv	open access http://purl.org/coar/access_right/c_abf2 Attribution-NonCommercial-NoDerivatives 4.0 Internacional http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv	info:eu-repo/semantics/openAccess
rights_invalid_str_mv	open access http://purl.org/coar/access_right/c_abf2 Attribution-NonCommercial-NoDerivatives 4.0 Internacional http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv	openAccess
dc.format.none.fl_str_mv	application/pdf
dc.source.none.fl_str_mv	reponame:ABACUS. Repositorio de Producción Científica instname:Universidad Europea (UEM)
instname_str	Universidad Europea (UEM)
reponame_str	ABACUS. Repositorio de Producción Científica
collection	ABACUS. Repositorio de Producción Científica
repository.name.fl_str_mv
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Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective obsertional study (COQUIMA cohort)

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