In:
PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 1 ( 2021-1-7), p. e0245025-
Abstract:
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.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0245025
DOI:
10.1371/journal.pone.0245025.g001
DOI:
10.1371/journal.pone.0245025.g002
DOI:
10.1371/journal.pone.0245025.g003
DOI:
10.1371/journal.pone.0245025.g004
DOI:
10.1371/journal.pone.0245025.g005
DOI:
10.1371/journal.pone.0245025.t001
DOI:
10.1371/journal.pone.0245025.t002
DOI:
10.1371/journal.pone.0245025.t003
DOI:
10.1371/journal.pone.0245025.t004
DOI:
10.1371/journal.pone.0245025.t005
DOI:
10.1371/journal.pone.0245025.t006
DOI:
10.1371/journal.pone.0245025.s001
DOI:
10.1371/journal.pone.0245025.s002
DOI:
10.1371/journal.pone.0245025.s003
DOI:
10.1371/journal.pone.0245025.r001
DOI:
10.1371/journal.pone.0245025.r002
DOI:
10.1371/journal.pone.0245025.r003
DOI:
10.1371/journal.pone.0245025.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2021
detail.hit.zdb_id:
2267670-3
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