BACKGROUND Mortality in critically ill COVID-19 patients remains high. Although randomized controlled trials must continue to definitively evaluate treatments, further hypothesis-generating efforts to identify candidate treatments are required. This study's hypothesis was that certain treatments are associated with lower COVID-19 mortality. METHODS This was a 1-yr retrospective cohort study involving all COVID-19 patients admitted to intensive care units in six hospitals affiliated with Yale New Haven Health System from February 13, 2020, to March 4, 2021. The exposures were any COVID-19-related pharmacologic and organ support treatments. The outcome was in-hospital mortality. RESULTS This study analyzed 2,070 patients after excluding 23 patients who died within 24 h after intensive care unit admission and 3 patients who remained hospitalized on the last day of data censoring. The in-hospital mortality was 29% (593 of 2,070). Of 23 treatments analyzed, apixaban (hazard ratio, 0.42; 95% CI, 0.363 to 0.48; corrected CI, 0.336 to 0.52) and aspirin (hazard ratio, 0.72; 95% CI, 0.60 to 0.87; corrected CI, 0.54 to 0.96) were associated with lower mortality based on the multivariable analysis with multiple testing correction. Propensity score-matching analysis showed an association between apixaban treatment and lower mortality (with vs. without apixaban, 27% [96 of 360] vs. 37% [133 of 360]; hazard ratio, 0.48; 95% CI, 0.337 to 0.69) and an association between aspirin treatment and lower mortality (with vs. without aspirin, 26% [121 of 473] vs. 30% [140 of 473]; hazard ratio, 0.57; 95% CI, 0.41 to 0.78). Enoxaparin showed similar associations based on the multivariable analysis (hazard ratio, 0.82; 95% CI, 0.69 to 0.97; corrected CI, 0.61 to 1.05) and propensity score-matching analysis (with vs. without enoxaparin, 25% [87 of 347] vs. 34% [117 of 347]; hazard ratio, 0.53; 95% CI, 0.367 to 0.77). CONCLUSIONS Consistent with the known hypercoagulability in severe COVID-19, the use of apixaban, enoxaparin, or aspirin was independently associated with lower mortality in critically ill COVID-19 patients. EDITOR’S PERSPECTIVE

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与重症 COVID-19 患者死亡率降低相关的治疗：一项回顾性队列研究。

背景 重症 COVID-19 患者的死亡率仍然很高。虽然随机对照试验必须继续明确评估治疗方法，但需要进一步的假设生成努力来确定候选治疗方法。该研究的假设是某些治疗与较低的 COVID-19 死亡率相关。方法 这是一项为期 1 年的回顾性队列研究，涉及 2020 年 2 月 13 日至 2021 年 3 月 4 日期间在耶鲁纽黑文卫生系统附属六家医院入住重症监护病房的所有 COVID-19 患者。暴露是任何 COVID-19 -相关的药物和器官支持治疗。结果是院内死亡率。结果 本研究分析了 2、剔除重症监护病房入院后 24 小时内死亡的 23 名患者和数据截尾最后一天仍住院的 3 名患者后，070 名患者。住院死亡率为 29%（2,070 人中有 593 人）。在分析的 23 种治疗中，阿哌沙班（风险比，0.42；95% CI，0.363 至 0.48；校正 CI，0.336 至 0.52）和阿司匹林（风险比，0.72；95% CI，0.60 至 0.87；校正 CI，0.964）基于多重检验校正的多变量分析与较低的死亡率相关。倾向评分匹配分析显示阿哌沙班治疗与较低死亡率之间存在关联（使用与不使用阿哌沙班，27% [96 of 360] vs. 37% [133 of 360]；风险比，0.48；95% CI，0.337 至 0.69） ) 以及阿司匹林治疗与较低死亡率之间的关联（使用与不使用阿司匹林，26% [121 of 473] vs. 30% [473 中的 140]；风险比，0.57；95% CI，0.41 至 0.78）。根据多变量分析（风险比，0.82；95% CI，0.69 至 0.97；校正 CI，0.61 至 1.05）和倾向评分匹配分析（使用与不使用依诺肝素，25% [87 of 347]），依诺肝素显示出相似的关联与 34% [117 of 347]；风险比，0.53；95% CI，0.367 至 0.77）。结论与已知的重症 COVID-19 高凝状态一致，使用阿哌沙班、依诺肝素或阿司匹林与 COVID-19 危重患者的较低死亡率独立相关。编辑的观点 25% [87 of 347] vs. 34% [117 of 347]；风险比，0.53；95% CI，0.367 至 0.77）。结论与已知的重症 COVID-19 高凝状态一致，使用阿哌沙班、依诺肝素或阿司匹林与 COVID-19 危重患者的较低死亡率独立相关。编辑的观点 25% [87 of 347] vs. 34% [117 of 347]；风险比，0.53；95% CI，0.367 至 0.77）。结论与已知的重症 COVID-19 高凝状态一致，使用阿哌沙班、依诺肝素或阿司匹林与 COVID-19 危重患者的较低死亡率独立相关。编辑的观点