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Impact of remdesivir according to the pre-admission symptom duration in patients with COVID-19

2021; Oxford University Press; Volume: 76; Issue: 12 Linguagem: Inglês

10.1093/jac/dkab321

1460-2091

Carolina García‐Vidal, Rodrigo Alonso, Ana M. Camon, Celia Cardozo, Laia Albiach, Daiana Agüero, María Ángeles Marcos, Juan Ambrosioni, Marta Bodro, Mariana Chumbita, Lorena de la Mora, Nicole García-Pouton, Gerard Dueñas, Marta Hernández‐Meneses, Alexy Inciarte, Genoveva Cuesta, Fernanda Meira, Laura Morata, Pedro Puerta‐Alcalde, Sabina Herrera, Montse Tuset, Pedro Castro, Sergio Prieto‐González, Alex Almuedo-Riera, Josep Mensa, José Antonio Martínez, Gemma Sanjuan, José M. Nicolás, Ana del Rı́o, José Muñóz, Jordi Vilà, Felipe García, Álex Soriano, José Luís Blanco, Josep Mallolas, Estebán Martínez, Miguel J. Martínez, José M. Miró, Antonio Moreno, M. Larroya Sola, Ainoa Ugarte, Ana González-Cordón, Montserrat Laguno, Lorna Leal, Juan Carlos Valerio-Rojas, Berta Torres, Silvia Fernández, Adrián Téllez, Fernando Fuentes, Mireia Urrea Ayala, D. Campubri, M. T. de Alba, M. Fernandez, Esther Jaén Ferrer, B. Grau, Helena Martí-Soler, Magdalena Muelas‐Fernandez, María‐Jesús Pinazo, Néstor Rodríguez, M. Roldan, Carme Subirá, Isabel Vera, Neely Williams, Alex Almuedo-Riera, José Muñóz, Anna Aldea, Miguel Camafort, Jorge Calvo, Abelardo Capdevila, Francesc Cardellach, Irene Carbonell, Emmanuel Coloma, Alberto Foncillas, Ramón Estruch, M. Feliu, Joaquim Fernández‐Solà, Irene Fuertes, Cristina Gabara, Ignacio Grafiá, A. Ladino, R. López-Alfaro, Alfonso López‐Soto, Irene Macaya, Ferrán Masanés, Arthur J. Matas, Mireia Navarro, Javier Marco‐Hernández, Lucas San Miguel, José C. Milisenda, Pedro R. Moreno, José Naval-Álvarez, David Nicolás, H.K. Oberoi, Joan Padrosa, Sergio Prieto‐González, Martina Pellicé, J. G. Ribot, Olga Rodríguez-Núñez, Emilio Sacanella, Ferran Seguí, Cristina Sierra, Adrià Tomé, Manuel Muñoz‐Torres, Helena Ventosa, Carles Zamora, Manuel Almela, Míriam J. Álvarez, J. Bosch, Josep Costa, Genoveva Cuesta, Berta Fidalgo, Júlia de Oliveira Gonzalez, Francesc Marco, Sofía Narváez, Cristina Pitart, Elisa Rubio, Ander Vergara, María Eugenia Valls, Yuliya Zboromyrska,

Sepsis Diagnosis and Treatment

Abstract Background The use of remdesivir has demonstrated a significant reduction in the time to recovery in patients with COVID-19. However, the impact on mortality is still controversial. Therefore, it is necessary to evaluate whether there is a specific subgroup of patients in whom an active antiviral therapy also reduces the mortality. Methods Patients admitted for >48 h in our hospital for a SARS-CoV-2 confirmed or suspected infection from February 2020 to February 2021 were retrospectively analysed. The primary outcome of the study was mortality at 30 days. Univariate and multivariate analyses were performed to identify predictors of mortality. Results In total, 2607 patients (438 receiving remdesivir and 2169 not) were included with a median (IQR) age of 65 (54–77) years and 58% were male. Four hundred and seventy-six were admitted to the ICU (18.3%) and 264 required invasive mechanical ventilation (10.1%). The global 30 day mortality rate was 10.7%. Pre-admission symptom duration of 4–6 days and ≤3 days was associated with a 1.5- and 2.5-fold increase in the mortality rate, respectively, in comparison with >6 days and treatment with remdesivir was independently associated with a lower mortality rate (OR = 0.382, 95% CI = 0.218–0.671). The analysis showed that the major difference was among patients with shorter pre-admission symptom duration (<6 days). Conclusions Patients with ≤3 days and 4–6 days from symptom onset to admission are associated with a 2.5- and 1.5-fold higher risk of death, respectively. Remdesivir was associated with 62% reduced odds of death versus standard-of-care and its survival benefit increased with shorter duration of symptoms.