PDF(Pubmed)
Abstract：
OBJECTIVE: Renal dysfunction is associated with poor outcomes in patients with coronavirus disease 2019 (COVID-19). In an effort to improve outcomes, intravenous remdesivir has been broadly used for the treatment of COVID-19 even in patients with low estimated glomerular filtration rate (eGFR). Our study assessed the residual risk of outcomes of patients with low eGFR despite treatment with remdesivir for COVID-19, during a timeframe prior to the expanded label across all levels of renal function.
METHODS: We conducted an observational, retrospective, multi-site cohort study of adults hospitalized with COVID-19 treated with at least one dose of remdesivir between November 6, 2020, and November 5, 2021. Electronic medical records were reviewed to obtain patient characteristics, related laboratory data, and outcomes. The primary endpoint was all-cause mortality by day 28. Multivariable logistic regression was used to evaluate association between groups.
RESULTS: The study population consisted of 3024 patients hospitalized with COVID-19 and treated with remdesivir. The median age was 67 [IQR 55, 77] years; 42.7% were women, and 88.6% were white. The median eGFR was 76.6 mL/min/1.73 m2 [IQR 52.5, 95.2]; the majority (67.2%) of patients had an eGFR ≥ 60, while 9% had an eGFR <30. All-cause mortality by day 28 was 8.7%. All-cause mortality rates were significantly higher among patients with impaired renal function (Odds Ratio [OR] 1.63 for patients with eGFR 30-59; OR 1.46 for eGFR 15-29; OR 2.42 for eGFR <15 and OR 5.44 for patients on dialysis) compared to patients with eGFR ≥60 mL/min/1.73m2.
CONCLUSIONS: Lower eGFR remains an independent risk factor for mortality in COVID-19 even in patients treated with remdesivir.
METHODS: We conducted an observational, retrospective, multi-site cohort study of adults hospitalized with COVID-19 treated with at least one dose of remdesivir between November 6, 2020, and November 5, 2021. Electronic medical records were reviewed to obtain patient characteristics, related laboratory data, and outcomes. The primary endpoint was all-cause mortality by day 28. Multivariable logistic regression was used to evaluate association between groups.
RESULTS: The study population consisted of 3024 patients hospitalized with COVID-19 and treated with remdesivir. The median age was 67 [IQR 55, 77] years; 42.7% were women, and 88.6% were white. The median eGFR was 76.6 mL/min/1.73 m2 [IQR 52.5, 95.2]; the majority (67.2%) of patients had an eGFR ≥ 60, while 9% had an eGFR <30. All-cause mortality by day 28 was 8.7%. All-cause mortality rates were significantly higher among patients with impaired renal function (Odds Ratio [OR] 1.63 for patients with eGFR 30-59; OR 1.46 for eGFR 15-29; OR 2.42 for eGFR <15 and OR 5.44 for patients on dialysis) compared to patients with eGFR ≥60 mL/min/1.73m2.
CONCLUSIONS: Lower eGFR remains an independent risk factor for mortality in COVID-19 even in patients treated with remdesivir.
摘要：
目标：肾功能不全与2019年冠状病毒病（COVID-19）患者的不良预后相关。为了改善结果，即使在估计肾小球滤过率(eGFR)较低的患者中,静脉注射雷德西韦也被广泛用于治疗COVID-19.我们的研究评估了eGFR低的患者在所有肾功能水平的扩大标签之前的一段时间内，尽管接受了雷米西韦治疗COVID-19，但其预后的残余风险。
方法：我们进行了一项观察，回顾性,在2020年11月6日至2021年11月5日期间接受至少一剂雷德西韦治疗的COVID-19住院成人的多中心队列研究.审查电子病历以获取患者特征，相关实验室数据，和结果。主要终点是28天的全因死亡率。使用多变量逻辑回归来评估组间的关联。
结果：研究人群包括3024例COVID-19住院并接受雷米西韦治疗的患者。中位年龄为67[55,77]岁;42.7%为女性,白人占88.6%。eGFR中位数为76.6mL/min/1.73m2[IQR52.5,95.2];大多数（67.2％）的患者eGFR≥60，而9％的患者eGFR<30。28天全因死亡率为8.7%。与eGFR≥60mL/min/1.73mL的患者相比，肾功能受损的患者的全因死亡率显着升高（eGFR30-59患者的赔率[OR]1.63；eGFR15-29的OR1.46；eGFR<15的OR2.42和透析患者的OR5.44）。
结论：较低的eGFR仍然是COVID-19患者死亡的独立危险因素，即使是在接受雷德西韦治疗的患者中也是如此。
方法：我们进行了一项观察，回顾性,在2020年11月6日至2021年11月5日期间接受至少一剂雷德西韦治疗的COVID-19住院成人的多中心队列研究.审查电子病历以获取患者特征，相关实验室数据，和结果。主要终点是28天的全因死亡率。使用多变量逻辑回归来评估组间的关联。
结果：研究人群包括3024例COVID-19住院并接受雷米西韦治疗的患者。中位年龄为67[55,77]岁;42.7%为女性,白人占88.6%。eGFR中位数为76.6mL/min/1.73m2[IQR52.5,95.2];大多数（67.2％）的患者eGFR≥60，而9％的患者eGFR<30。28天全因死亡率为8.7%。与eGFR≥60mL/min/1.73mL的患者相比，肾功能受损的患者的全因死亡率显着升高（eGFR30-59患者的赔率[OR]1.63；eGFR15-29的OR1.46；eGFR<15的OR2.42和透析患者的OR5.44）。
结论：较低的eGFR仍然是COVID-19患者死亡的独立危险因素，即使是在接受雷德西韦治疗的患者中也是如此。
