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羟氯喹治疗Covid-19住院患者与插管或死亡风险无关
作者:小柯机器人 发布时间:2020/5/9 21:14:10

美国哥伦比亚大学欧文医学中心Neil W. Schluger团队进行了一项羟氯喹治疗Covid-19住院患者的观察研究。2020年5月7日,《新英格兰医学杂志》发表了这一成果。

在没有有力证据支持的情况下,羟氯喹已被广泛用于治疗Covid-19患者。研究组在纽约市的一家大型医疗中心分析了羟氯喹使用与插管或死亡之间的关联,使用Covid-19住院患者的连续数据,主要终点事件是插管或死亡的综合结果。

在1446例连续住院患者中,有70例患者在就诊后24小时内被插管、死亡或出院,被排除在分析之外。其余1376名患者在22.5天的中位随访期间,有811名(58.9%)接受了羟氯喹治疗,45.8%的患者在就诊后24小时内得到了治疗,85.9%的患者在就诊后48小时内得到了治疗。

与未接受羟氯喹治疗的患者相比,接受羟氯喹治疗的患者在基线时病情更重。总体而言,共有346例患者(25.1%)发生主要终点事件,其中180例进行了插管,66例随后死亡;166例患者未进行插管而死亡。在主要分析中,使用羟氯喹与插管或死亡之间没有显著关联。多重敏感性分析的结果相似。

总之,在这项涉及Covid-19住院患者的观察性研究中,羟氯喹的使用与插管或死亡复合终点的风险无关。

附:英文原文

Title: Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19

Author: Joshua Geleris, M.D.,, Yifei Sun, Ph.D.,, Jonathan Platt, Ph.D.,, Jason Zucker, M.D.,, Matthew Baldwin, M.D.,, George Hripcsak, M.D.,, Angelena Labella, M.D.,, Daniel Manson, M.D.,, Christine Kubin, Pharm.D.,, R. Graham Barr, M.D., Dr.P.H.,, Magdalena E. Sobieszczyk, M.D., M.P.H.,, and Neil W. Schluger, M.D.

Issue&Volume: 2020-05-07

Abstract: BACKGROUND

Hydroxychloroquine has been widely administered to patients with Covid-19 without robust evidence supporting its use.

METHODS

We examined the association between hydroxychloroquine use and intubation or death at a large medical center in New York City. Data were obtained regarding consecutive patients hospitalized with Covid-19, excluding those who were intubated, died, or discharged within 24 hours after presentation to the emergency department (study baseline). The primary end point was a composite of intubation or death in a time-to-event analysis. We compared outcomes in patients who received hydroxychloroquine with those in patients who did not, using a multivariable Cox model with inverse probability weighting according to the propensity score.

RESULTS

Of 1446 consecutive patients, 70 patients were intubated, died, or discharged within 24 hours after presentation and were excluded from the analysis. Of the remaining 1376 patients, during a median follow-up of 22.5 days, 811 (58.9%) received hydroxychloroquine (600 mg twice on day 1, then 400 mg daily for a median of 5 days); 45.8% of the patients were treated within 24 hours after presentation to the emergency department, and 85.9% within 48 hours. Hydroxychloroquine-treated patients were more severely ill at baseline than those who did not receive hydroxychloroquine (median ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen, 223 vs. 360). Overall, 346 patients (25.1%) had a primary end-point event (180 patients were intubated, of whom 66 subsequently died, and 166 died without intubation). In the main analysis, there was no significant association between hydroxychloroquine use and intubation or death (hazard ratio, 1.04, 95% confidence interval, 0.82 to 1.32). Results were similar in multiple sensitivity analyses.

CONCLUSIONS

In this observational study involving patients with Covid-19 who had been admitted to the hospital, hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of the composite end point of intubation or death. Randomized, controlled trials of hydroxychloroquine in patients with Covid-19 are needed.

DOI: 10.1056/NEJMoa2012410

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2012410

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home