Abstract

Background

Remdesivir is a prodrug with in vitro activity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Its clinical efficacy in patients with COVID-19 under mechanical ventilation remains to be evaluated.

Methods

This study includes patients under mechanical ventilation with confirmed SARS-CoV-2 infection admitted to the ICU of Pesaro hospital between 29 February and 20 March 2020. During this period, remdesivir was provided on a compassionate use basis. Clinical characteristics and outcome of patients treated with remdesivir were collected retrospectively and compared with those of patients hospitalized in the same time period.

Results

A total of 51 patients were considered, of which 25 were treated with remdesivir. The median (IQR) age was 67 (59–75.5) years, 92% were men and symptom onset was 10 (8–12) days before admission to ICU. At baseline, there was no significant difference in demographic characteristics, comorbidities and laboratory values between patients treated and not treated with remdesivir. Median follow-up was 52 (46–57) days. Kaplan–Meier curves showed significantly lower mortality among patients who had been treated with remdesivir (56% versus 92%, P < 0.001). Cox regression analysis showed that the Charlson Comorbidity Index was the only factor that had a significant association with higher mortality (OR 1.184; 95% CI 1.027–1.365; P = 0.020), while the use of remdesivir was associated with better survival (OR 3.506; 95% CI 1.768–6.954; P < 0.001).

Conclusions

In this study the mortality rate of patients with COVID-19 under mechanical ventilation is confirmed to be high. The use of remdesivir was associated with a significant beneficial effect on survival.

中文翻译：

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瑞德西韦对意大利 ICU 机械通气下的 COVID-19 患者的有效性。

摘要

背景

瑞德西韦是一种前药，具有抗严重急性呼吸综合征冠状病毒-2 (SARS-CoV-2) 的体外活性。其在机械通气下的 COVID-19 患者中的临床疗效仍有待评估。

方法

这项研究包括 2020 年 2 月 29 日至 3 月 20 日入住佩萨罗医院 ICU 的确诊 SARS-CoV-2 感染的机械通气患者。在此期间，瑞德西韦是在同情使用的基础上提供的。回顾性收集瑞德西韦治疗患者的临床特征和转归，并与同期住院患者进行比较。

结果

总共考虑了 51 名患者，其中 25 名接受瑞德西韦治疗。中位年龄 (IQR) 为 67 (59–75.5) 岁，92% 为男性，症状出现于入住 ICU 前 10 (8–12) 天。在基线时，接受瑞德西韦治疗和未接受瑞德西韦治疗的患者之间的人口统计学特征、合并症和实验室值没有显着差异。中位随访时间为 52 (46–57) 天。Kaplan-Meier 曲线显示，接受瑞德西韦治疗的患者死亡率显着降低（56% 对比 92%，P  < 0.001）。Cox回归分析显示，查尔森合并症指数是唯一与较高死亡率显着相关的因素（OR 1.184；95% CI 1.027–1.365；P  = 0.020），而使用瑞德西韦与更好的生存率相关（OR 3.506） ；95% CI 1.768–6.954；P  < 0.001）。

结论

本研究证实机械通气下的 COVID-19 患者死亡率较高。瑞德西韦的使用对生存有显着的有益影响。