Different COVID-19 treatments’ impact on hospital length of stay
Abstract Importance COVID-19 has adversely affected global healthcare infrastructure since 2019. Currently, there are no large-scale published reports on the efficacy of combination therapy of dexamethasone, remdesivir, and tocilizumab on COVID-19 patients. Objectives Is the combination therapy of d...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-07-01
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| Series: | European Journal of Medical Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40001-023-01201-8 |
| _version_ | 1827905632022298624 |
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| author | Satori Iwamoto Bahaar Kaur Muhar Hao Chen Harrison Chu Mason Johnstone Ashwin Sidhu Hillary Chu Joseph Fischer Gary Chu |
| author_facet | Satori Iwamoto Bahaar Kaur Muhar Hao Chen Harrison Chu Mason Johnstone Ashwin Sidhu Hillary Chu Joseph Fischer Gary Chu |
| author_sort | Satori Iwamoto |
| collection | DOAJ |
| description | Abstract Importance COVID-19 has adversely affected global healthcare infrastructure since 2019. Currently, there are no large-scale published reports on the efficacy of combination therapy of dexamethasone, remdesivir, and tocilizumab on COVID-19 patients. Objectives Is the combination therapy of dexamethasone, remdesivir, and tocilizumab superior to other treatments on hospitalized COVID-19 patients? Design This is a retrospective, comparative effectiveness study. Setting Single-center study Participants/interventions We analyzed different inpatient COVID-19 treatment options available in the United States and their impact on hospital length of stay (LOS) and mortality. Hospitalized COVID-19 were categorized as “mild,” “moderate” and “severe'' based on the highest level of oxygen required; room air, nasal cannula, or high flow/PAP/intubation, respectively. Patients were treated in accordance with the availability of medications and the latest treatment guidelines. Main outcomes The endpoints of the study are hospital discharges and death during hospitalization. Results 1233 COVID-19 patients were admitted from 2020 to 2021. No treatment combinations showed a statistically significant decrease in hospital LOS in mild COVID-19 patients (p = 0.186). In moderate patients, the combination of remdesivir and dexamethasone slightly decreased LOS by 1 day (p = 0.007). In severe patients, the three-drug combination of remdesivir, dexamethasone, and tocilizumab decreased LOS by 8 days (p = 0.0034) when compared to nonviable treatments, such as hydroxychloroquine and convalescent plasma transfusion. However, it did not show any statistically significant benefit when compared to two-drug regimens (dexamethasone plus remdesivir) in severe COVID-19 (p = 0.116). No treatment arm appeared to show a statistically significant decrease in mortality for severe COVID-19 patients. Conclusions Our findings suggest that three-drug combination may decrease LOS in severe COVID-19 patients when compared to two-drug therapy. However, the trend was not supported by statistical analysis. Remdesivir may not be clinically beneficial for mild hospitalized COVID-19 patients; considering its cost, one could reserve it for moderate and severe patients. Triple drug therapies, while potentially reducing LOS for severe patients, do not affect overall mortality. Additional patient data may increase statistical power and solidify these findings. |
| first_indexed | 2024-03-13T00:44:02Z |
| format | Article |
| id | doaj.art-dee51304fd774d69bc8663a419439cb8 |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-03-13T00:44:02Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-dee51304fd774d69bc8663a419439cb82023-07-09T11:09:37ZengBMCEuropean Journal of Medical Research2047-783X2023-07-0128111010.1186/s40001-023-01201-8Different COVID-19 treatments’ impact on hospital length of staySatori Iwamoto0Bahaar Kaur Muhar1Hao Chen2Harrison Chu3Mason Johnstone4Ashwin Sidhu5Hillary Chu6Joseph Fischer7Gary Chu8California Northstate University College of MedicineCalifornia Northstate University College of MedicineDepartment of Respiratory Internal Medicine, Yokohama City UniversityCalifornia Northstate University College of MedicineCalifornia Northstate University College of MedicineCalifornia Northstate University College of MedicineCalifornia Northstate University College of MedicineCalifornia Northstate University College of MedicineCalifornia Northstate University College of MedicineAbstract Importance COVID-19 has adversely affected global healthcare infrastructure since 2019. Currently, there are no large-scale published reports on the efficacy of combination therapy of dexamethasone, remdesivir, and tocilizumab on COVID-19 patients. Objectives Is the combination therapy of dexamethasone, remdesivir, and tocilizumab superior to other treatments on hospitalized COVID-19 patients? Design This is a retrospective, comparative effectiveness study. Setting Single-center study Participants/interventions We analyzed different inpatient COVID-19 treatment options available in the United States and their impact on hospital length of stay (LOS) and mortality. Hospitalized COVID-19 were categorized as “mild,” “moderate” and “severe'' based on the highest level of oxygen required; room air, nasal cannula, or high flow/PAP/intubation, respectively. Patients were treated in accordance with the availability of medications and the latest treatment guidelines. Main outcomes The endpoints of the study are hospital discharges and death during hospitalization. Results 1233 COVID-19 patients were admitted from 2020 to 2021. No treatment combinations showed a statistically significant decrease in hospital LOS in mild COVID-19 patients (p = 0.186). In moderate patients, the combination of remdesivir and dexamethasone slightly decreased LOS by 1 day (p = 0.007). In severe patients, the three-drug combination of remdesivir, dexamethasone, and tocilizumab decreased LOS by 8 days (p = 0.0034) when compared to nonviable treatments, such as hydroxychloroquine and convalescent plasma transfusion. However, it did not show any statistically significant benefit when compared to two-drug regimens (dexamethasone plus remdesivir) in severe COVID-19 (p = 0.116). No treatment arm appeared to show a statistically significant decrease in mortality for severe COVID-19 patients. Conclusions Our findings suggest that three-drug combination may decrease LOS in severe COVID-19 patients when compared to two-drug therapy. However, the trend was not supported by statistical analysis. Remdesivir may not be clinically beneficial for mild hospitalized COVID-19 patients; considering its cost, one could reserve it for moderate and severe patients. Triple drug therapies, while potentially reducing LOS for severe patients, do not affect overall mortality. Additional patient data may increase statistical power and solidify these findings.https://doi.org/10.1186/s40001-023-01201-8COVID-19Length of stayMortality |
| spellingShingle | Satori Iwamoto Bahaar Kaur Muhar Hao Chen Harrison Chu Mason Johnstone Ashwin Sidhu Hillary Chu Joseph Fischer Gary Chu Different COVID-19 treatments’ impact on hospital length of stay European Journal of Medical Research COVID-19 Length of stay Mortality |
| title | Different COVID-19 treatments’ impact on hospital length of stay |
| title_full | Different COVID-19 treatments’ impact on hospital length of stay |
| title_fullStr | Different COVID-19 treatments’ impact on hospital length of stay |
| title_full_unstemmed | Different COVID-19 treatments’ impact on hospital length of stay |
| title_short | Different COVID-19 treatments’ impact on hospital length of stay |
| title_sort | different covid 19 treatments impact on hospital length of stay |
| topic | COVID-19 Length of stay Mortality |
| url | https://doi.org/10.1186/s40001-023-01201-8 |
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