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Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan
The pharmacological management of COVID-19 has evolved significantly and various immunomodulatory agents have been repurposed. However, the clinical efficacy has been variable and a search for cure for COVID-19 continues. A retrospective cohort study was conducted on 916 patients hospitalized with p...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8794194/ https://www.ncbi.nlm.nih.gov/pubmed/35085312 http://dx.doi.org/10.1371/journal.pone.0262608 |
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author | Nasir, Noreen Tajuddin, Salma Khaskheli, Sarah Khan, Naveera Niamatullah, Hammad Nasir, Nosheen |
author_facet | Nasir, Noreen Tajuddin, Salma Khaskheli, Sarah Khan, Naveera Niamatullah, Hammad Nasir, Nosheen |
author_sort | Nasir, Noreen |
collection | PubMed |
description | The pharmacological management of COVID-19 has evolved significantly and various immunomodulatory agents have been repurposed. However, the clinical efficacy has been variable and a search for cure for COVID-19 continues. A retrospective cohort study was conducted on 916 patients hospitalized with polymerase chain reaction (PCR)-confirmed COVID-19 between February 2020 and October 2020 at a tertiary care academic medical center in Karachi, Pakistan. The median age was 57 years (interquartile range (IQR) 46–66 years). The most common medications administered were Methylprednisolone (65.83%), Azithromycin (50.66%), and Dexamethasone (46.6%). Majority of the patients (70%) had at least two or more medications used in combination and the most frequent combination was methylprednisolone with azithromycin. Overall in-hospital mortality was 13.65% of patients. Mortality was found to be independently associated with age greater than or equal to 60 years (OR = 4.98; 95%CI: 2.78–8.91), critical illness on admission (OR = 13.75; 95%CI: 7.27–25.99), use of hydrocortisone (OR = 12.56; 95%CI: 6.93–22.7), Ferritin> = 1500(OR = 2.07; 95%CI: 1.18–3.62), Creatinine(OR = 2.33; 95%CI: 1.31–4.14) and D-Dimer> = 1.5 (OR = 2.27; 95%CI: 1.26–4.07). None of the medications whether used as monotherapy or in combination were found to have a mortality benefit. Our study highlights the desperate need for an effective drug for the management of critical COVID-19 which necessitates usage of multiple drug combinations in patients particularly Azithromycin which has long term implications for antibiotic resistance particularly in low-middle income countries. |
format | Online Article Text |
id | pubmed-8794194 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-87941942022-01-28 Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan Nasir, Noreen Tajuddin, Salma Khaskheli, Sarah Khan, Naveera Niamatullah, Hammad Nasir, Nosheen PLoS One Research Article The pharmacological management of COVID-19 has evolved significantly and various immunomodulatory agents have been repurposed. However, the clinical efficacy has been variable and a search for cure for COVID-19 continues. A retrospective cohort study was conducted on 916 patients hospitalized with polymerase chain reaction (PCR)-confirmed COVID-19 between February 2020 and October 2020 at a tertiary care academic medical center in Karachi, Pakistan. The median age was 57 years (interquartile range (IQR) 46–66 years). The most common medications administered were Methylprednisolone (65.83%), Azithromycin (50.66%), and Dexamethasone (46.6%). Majority of the patients (70%) had at least two or more medications used in combination and the most frequent combination was methylprednisolone with azithromycin. Overall in-hospital mortality was 13.65% of patients. Mortality was found to be independently associated with age greater than or equal to 60 years (OR = 4.98; 95%CI: 2.78–8.91), critical illness on admission (OR = 13.75; 95%CI: 7.27–25.99), use of hydrocortisone (OR = 12.56; 95%CI: 6.93–22.7), Ferritin> = 1500(OR = 2.07; 95%CI: 1.18–3.62), Creatinine(OR = 2.33; 95%CI: 1.31–4.14) and D-Dimer> = 1.5 (OR = 2.27; 95%CI: 1.26–4.07). None of the medications whether used as monotherapy or in combination were found to have a mortality benefit. Our study highlights the desperate need for an effective drug for the management of critical COVID-19 which necessitates usage of multiple drug combinations in patients particularly Azithromycin which has long term implications for antibiotic resistance particularly in low-middle income countries. Public Library of Science 2022-01-27 /pmc/articles/PMC8794194/ /pubmed/35085312 http://dx.doi.org/10.1371/journal.pone.0262608 Text en © 2022 Nasir et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Nasir, Noreen Tajuddin, Salma Khaskheli, Sarah Khan, Naveera Niamatullah, Hammad Nasir, Nosheen Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan |
title | Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan |
title_full | Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan |
title_fullStr | Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan |
title_full_unstemmed | Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan |
title_short | Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan |
title_sort | clinical outcomes of immunomodulatory therapies in the management of covid-19: a tertiary-care experience from pakistan |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8794194/ https://www.ncbi.nlm.nih.gov/pubmed/35085312 http://dx.doi.org/10.1371/journal.pone.0262608 |
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