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).