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Clinical predictors at admission and combined treatment for COVID-19 outcomes
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  • Maiara Floriani,
  • Marina Bessel,
  • Isabelle Zorzo,
  • Andressa Glaeser,
  • Rafael Grando,
  • Raphael Rodeghiero,
  • Mohamed Parrini,
  • Gisele Nader Bastos,
  • Luiz Nasi
Maiara Floriani
Hospital Moinhos de Vento
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Marina Bessel
Hospital Moinhos de Vento
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Isabelle Zorzo
Hospital Moinhos de Vento
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Andressa Glaeser
Hospital Moinhos de Vento
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Rafael Grando
Hospital Moinhos de Vento
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Raphael Rodeghiero
Hospital Moinhos de Vento
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Mohamed Parrini
Hospital Moinhos de Vento
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Gisele Nader Bastos
Hospital Moinhos de Vento
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Luiz Nasi
Hospital Moinhos de Vento
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Abstract

Aims of the study: To investigate the effect of clinical predictors on admission and the set of therapeutic interventions on length of stay, ICU admission, need for MV and mortality. Methods used to conduct the study: Retrospective cohort of inpatients with RT-PCR positive for COVID-19 from March to July 2020. Multivariate models were used to assess risk for ICU admission, need for MV and hospital mortality. Logistic regression analysis was conducted to examine factors associated with the results. Results of the study: 459 patients were enrolled (median age 60.0 years old). For patients treated with AZM-Corticosteroid (46.8%) the risk for ICU admission was 0.17 (OR; 95%CI 0.05-0.57), for MV 0.16 (OR; 95%CI 0.04-0.74) and for mortality 0.16 (OR; 95%CI 0.03-0.91). AZM-Corticosteroid also decreased the length of stay in 1.5 day. AZM-Corticosteroid and anticoagulation when indicated (17.2%), also reduced the ICU stay in 1.5 and MV in 4 days. When included HCQ, the benefits were lost and the times increased. Age >65 years, presence of up one comorbidity, pulmonary involvement more than or equal to 50%, saturation <93%, lymphocytes <900 mm3, D-dimers >1,250 ng/mL and CRP >8.0 mg/dL at admission were clinical predictors for death. HFNC was able to prevent intubation by 38.1%. Conclusion drawn from the study and clinical implications: AZM-Corticosteroids and anticoagulation represented a favorable combination for inpatients with COVID-19, reducing length of hospitalization, risk of MV and mortality. HCQ did not yield benefits to combination therapy and we do not support its use for inpatients. HFNC was able to prevent intubation in one third of patients. Already on admission some clinical predictors may help to estimate a higher risk of poor evolution.