SARS-CoV-2 omicron变异体时代严重免疫力低下的COVID-19门诊患者早期抗SARS治疗的实际效果:倾向得分调整的回顾性队列研究。

IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Journal of Antimicrobial Chemotherapy Pub Date : 2024-10-07 DOI:10.1093/jac/dkae351
Héctor Pinargote-Celorio, Óscar Moreno-Pérez, Pilar González-De-La-Aleja, Jara Llenas-García, Pedro María Martínez Pérez-Crespo, Juan-Carlos Rodríguez-Díaz, Belén Martínez-López, Nicolás Merchante Gutiérrez, José-Manuel Ramos-Rincón, Esperanza Merino
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引用次数: 0

摘要

背景:SARS-CoV-2 感染早期抗病毒药物治疗的效果与患者的合并症密切相关。有关免疫力低下患者疗效的数据十分有限,报告涉及的人群高度不均且定义不清。我们的目的是评估治疗对减少严重免疫力低下的 COVID-19 门诊患者住院率的有效性:我们对 2022 年 1 月 1 日至 12 月 31 日期间在传染病科就诊的免疫力低下门诊患者进行了一项多中心、回顾性、观察性队列研究。研究采用倾向得分匹配(PSM)多变量逻辑回归模型来估算抗病毒药物处方与治疗结果(COVID-19相关住院至第90天)之间的调整赔率[(aOR,95%置信区间(CI)]:我们确定了 746 名确诊感染 SARS-CoV-2 的免疫力低下的门诊患者。根据资格标准和 PSM,共对 410 名患者进行了分析:205 名接受治疗(雷米地韦、索罗维单抗或尼马瑞韦/利托那韦),205 名为匹配对照。52名患者需要至少一次与COVID-19相关的住院治疗,抗病毒治疗组和匹配对照组分别为8人(3.9%)和44人(21.5%)。90 天内有 13 人死亡,其中只有 4 人与 COVID-19 相关,抗病毒治疗组无一人死亡。对残余混杂因素进行调整后,早期治疗对住院风险有保护作用[aOR 0.13 (0.05-0.29)],使用生物免疫调节剂也有保护作用[aOR 0.27 (0.10-0.74)],而慢性阻塞性肺病[aOR 4.65 (1.09-19.69)]和抗CD20[aOR 2.76 (1.31-5.81)]会增加住院风险:结论:早期抗病毒治疗可降低COVID-19相关住院风险。
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Real-world effectiveness of early anti-SARS therapy in severely immunocompromised COVID-19 outpatients during the SARS-CoV-2 omicron variant era: a propensity score-adjusted retrospective cohort study.

Background: The effectiveness of the early treatment for antiviral agents in SARS-CoV-2 infection is closely related to patient comorbidities. Data on effectiveness in immunocompromised patients are limited, with reports involving highly heterogeneous and not well-defined populations. We aimed to assess the effectiveness of treatment in reducing hospitalizations in a real-world cohort of severely immunocompromised COVID-19 outpatients.

Patients and methods: We conducted a multicentre, retrospective, observational cohort study of immunocompromised outpatients attended in infectious diseases departments from 1 January to 31 December 2022. Propensity score matching (PSM) multivariable logistic regression models were used to estimate the adjusted odds ratio [(aOR, 95% confidence interval (CI)] for the association between antiviral prescription and outcome (COVID-19-related hospitalization up to Day 90).

Results: We identified 746 immunocompromised outpatients with confirmed SARS-CoV-2 infection. After eligibility criteria and PSM, a total of 410 patients were analysed: 205 receiving treatment (remdesivir, sotrovimab or nirmatrelvir/ritonavir) and 205 matched controls. Fifty-two patients required at least one COVID-19-related hospitalization 8 (3.9%) versus 44 (21.5%) in the antiviral and matched control cohorts, respectively. There were 13 deaths at 90 days, of which only 4 were COVID-19-related and none in the antiviral treatment group. After adjustment for residual confounders, the use of early therapy was associated with a protective effect on the risk of hospitalization [aOR 0.13 (0.05-0.29)], as was the use of biological immunomodulators [aOR 0.27 (0.10-0.74)], whereas chronic obstructive pulmonary disease [aOR 4.65 (1.09-19.69)] and anti-CD20 use [aOR 2.76 (1.31-5.81)] increased the odds.

Conclusions: Early antiviral treatment was associated with a reduced risk of COVID-19-related hospitalization in ambulatory severely immunocompromised COVID-19 patients.

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来源期刊
CiteScore
9.20
自引率
5.80%
发文量
423
审稿时长
2-4 weeks
期刊介绍: The Journal publishes articles that further knowledge and advance the science and application of antimicrobial chemotherapy with antibiotics and antifungal, antiviral and antiprotozoal agents. The Journal publishes primarily in human medicine, and articles in veterinary medicine likely to have an impact on global health.
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