METHODS
Observational retrospective analysis of patients (aged ≥18 years) with RT-PCR positive for COVID-19 obtained from nasal and pharyngeal swabs, admitted from March 15 to July 31, 2020 at Hospital Moinhos de Vento, a teaching private hospital, with 500 beds and reference for the treatment of patients with COVID-19 in the South of Brazil4.
Outcomes of different treatment combinations used in standard care were evaluated: HCQ, azithromycin (AZM), corticosteroids (dexamethasone, hydrocortisone or methylprednisolone), tocilizumab, oseltamivir, convalescent plasma, therapeutic anticoagulation and different ways of improving oxygen without positive pressure (nasal catheter and Hudson mask) and with positive pressure (high flow nasal cannula (HFNC), Bi-level Airway Positive Pressure (BiPAP) and MV). Therapeutic anticoagulation was considered with intention-to-treat for patients with deep venous thrombosis (DVT), pulmonary embolism (PE) or D-dimers elevated. Obese people (body mass index ≥30), lymphopenia (lymphocytes <900 mm³), D-dimers >1,250 ng/mL and C-reactive protein (CRP) >8.0 mg/dL were considered abnormal values. The usual dose of corticosteroids used was ≤0.5–1 mg/kg per day of methylprednisolone or equivalent. The pulmonary impairment was assessed on a visual scale by two independent chest radiologists trained to interpreted COVID-19 patients.
Primary endpoint was building up a COVID-19 predictor model based on individual-level data to estimate the risk for ICU admission, need for MV and hospital mortality. Additionally, three secondary endpoints were established: 1) the impact of combined interventions on hospital length of stay, ICU and MV, 2) likelihood that different ways of noninvasive oxygen administration prevent MV and 3) which clinical predictors are relevant to poor outcome (mortality). The Institutional Ethics Committee approved this study (CAAE 30350820.5.2037.5330).