Fernando Valerio Pascua1, Oscar Diaz2, Rina Medina3, Brian Contreras4, Jeff Mistroff4, Daniel Espinosa5, Anupamjeet Sekhon6, Diego Paz Handal7, Estela Pineda8, Miguel Vargas Pineda8, Hector Pineda9, Maribel Diaz10, Anita S Lewis11, Heike Hesse12, Miriams T Castro Lainez13, Mark L Stevens14, Miguel Sierra-Hoffman15, Sidney C Ontai16, Vincent VanBuren17. 1. Department of Critical Care Hospital Leonardo Martínez, San Pedro Sula, Cortés, Honduras. 2. Department of Critical Care Hospital Regional del Norte Instituto Hondureño de Seguridad Social, San Pedro Sula, Cortés, Honduras. 3. Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras. 4. Detar Family Medicine Residency Program, Texas A&M College of Medicine Victoria, Victoria, TX, United States of America. 5. Victoria Hospitalist Associates, Detar Hospital, Victoria, TX, United States of America. 6. Detar Family Medicine Residency Program, Texas A&M College of Medicine, Victoria, TX, United States of America. 7. Universidad Nacional Autónoma de Honduras, San Pedro Sula, Cortés, Honduras. 8. Hospital Leonardo Martínez, San Pedro Sula, Cortés, Honduras. 9. Department of Neurology, Hospital Mario Catarino Rivas, San Pedro Sula, Cortés, Honduras. 10. Department of Allergy and Immunology, Instituto Hondureño de Seguridad Social, Sociedad Hondureña de Inmunología, Tegucigalpa, Honduras. 11. Pharmacy Department, El Campo Memorial Hospital, El Campo, TX, United States of America. 12. Neurology Department, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras. 13. Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras. 14. Research Department, Texas A&M College of Medicine, Detar Family Medicine Residency Program, Victoria, TX, United States of America. 15. Research and Infectious Disease Department, Texas A&M College of Medicine, Detar Family Medicine Residency Program, Victoria, TX, United States of America. 16. Detar Family Medicine Residency Program Department, Texas A&M University College of Medicine, Victoria, TX, United States of America. 17. Round Rock Clinical Campus, Texas A&M College of Medicine, Round Rock, TX, United States of America.
Abstract
PURPOSE: COVID-19 pandemic has multifaceted presentations with rising evidence of immune-mediated mechanisms underplay. We sought to explore the outcomes of severe COVID-19 patients treated with a multi-mechanism approach (MMA) in addition to standard-of-care (SC) versus patients who only received SC treatment. MATERIALS AND METHODS: Data were collected retrospectively for patients admitted to the intensive care unit (ICU). This observational cohort study was performed at five institutions, 3 in the United States and 2 in Honduras. Patients were stratified for MMA vs. SC treatment during ICU stay. MMA treatment consists of widely available medications started immediately upon hospitalization. These interventions target immunomodulation, anticoagulation, viral suppression, and oxygenation. Primary outcomes included in-hospital mortality and length of stay (LOS) for the index hospitalization and were measured using logistic regression. RESULTS: Of 86 patients admitted, 65 (76%) who had severe COVID-19 were included in the study; 30 (46%) patients were in SC group, compared with 35 (54%) patients treated with MMA group. Twelve (40%) patients in the SC group died, compared with 5 (14%) in the MMA group (p-value = 0.01, Chi squared test). After adjustment for gender, age, treatment group, Q-SOFA score, the MMA group had a mean length of stay 8.15 days, when compared with SC group with 13.55 days. ICU length of stay was reduced by a mean of 5.4 days (adjusted for a mean age of 54 years, p-value 0.03) and up to 9 days (unadjusted for mean age), with no significant reduction in overall adjusted mortality rate, where the strongest predictor of mortality was the use of mechanical ventilation. CONCLUSION: The finding that MMA decreases the average ICU length of stay by 5.4 days and up to 9 days in older patients suggests that implementation of this treatment protocol could allow a healthcare system to manage 60% more COVID-19 patients with the same number of ICU beds.
PURPOSE:COVID-19 pandemic has multifaceted presentations with rising evidence of immune-mediated mechanisms underplay. We sought to explore the outcomes of severe COVID-19patients treated with a multi-mechanism approach (MMA) in addition to standard-of-care (SC) versus patients who only received SC treatment. MATERIALS AND METHODS: Data were collected retrospectively for patients admitted to the intensive care unit (ICU). This observational cohort study was performed at five institutions, 3 in the United States and 2 in Honduras. Patients were stratified for MMA vs. SC treatment during ICU stay. MMA treatment consists of widely available medications started immediately upon hospitalization. These interventions target immunomodulation, anticoagulation, viral suppression, and oxygenation. Primary outcomes included in-hospital mortality and length of stay (LOS) for the index hospitalization and were measured using logistic regression. RESULTS: Of 86 patients admitted, 65 (76%) who had severe COVID-19 were included in the study; 30 (46%) patients were in SC group, compared with 35 (54%) patients treated with MMA group. Twelve (40%) patients in the SC group died, compared with 5 (14%) in the MMA group (p-value = 0.01, Chi squared test). After adjustment for gender, age, treatment group, Q-SOFA score, the MMA group had a mean length of stay 8.15 days, when compared with SC group with 13.55 days. ICU length of stay was reduced by a mean of 5.4 days (adjusted for a mean age of 54 years, p-value 0.03) and up to 9 days (unadjusted for mean age), with no significant reduction in overall adjusted mortality rate, where the strongest predictor of mortality was the use of mechanical ventilation. CONCLUSION: The finding that MMA decreases the average ICU length of stay by 5.4 days and up to 9 days in older patients suggests that implementation of this treatment protocol could allow a healthcare system to manage 60% more COVID-19patients with the same number of ICU beds.
Authors: Matthew J Cummings; Matthew R Baldwin; Darryl Abrams; Samuel D Jacobson; Benjamin J Meyer; Elizabeth M Balough; Justin G Aaron; Jan Claassen; LeRoy E Rabbani; Jonathan Hastie; Beth R Hochman; John Salazar-Schicchi; Natalie H Yip; Daniel Brodie; Max R O'Donnell Journal: Lancet Date: 2020-05-19 Impact factor: 79.321
Authors: Marion M Mafham; Enti Spata; Raphael Goldacre; Dominic Gair; Paula Curnow; Mark Bray; Sam Hollings; Chris Roebuck; Chris P Gale; Mamas A Mamas; John E Deanfield; Mark A de Belder; Thomas F Luescher; Tom Denwood; Martin J Landray; Jonathan R Emberson; Rory Collins; Eva J A Morris; Barbara Casadei; Colin Baigent Journal: Lancet Date: 2020-07-14 Impact factor: 79.321
Authors: Ba Pham; Patricia Rios; Amruta Radhakrishnan; Nazia Darvesh; Jesmin Antony; Chantal Williams; Naveeta Ramkissoon; Gordon V Cormack; Maura R Grossman; Melissa Kampman; Milan Patel; Fatemeh Yazdi; Reid Robson; Marco Ghassemi; Erin Macdonald; Rachel Warren; Matthew P Muller; Sharon E Straus; Andrea C Tricco Journal: BMJ Open Date: 2022-06-03 Impact factor: 3.006