Abstract：
BACKGROUND: Antiviral drugs have become crucial in managing COVID-19, reducing complications and mortality. Remdesivir has emerged as an effective therapeutic drug for hospitalized patients at risk of disease progression, especially when alternative treatments are infeasible. While the recommended treatment duration of remdesivir extends up to 7 days post-symptom onset, this study examines how early remdesivir administration impacts clinical outcomes.
METHODS: We conducted a retrospective analysis using clinical data from consecutively PCR confirmed SARS-CoV‑2 adult patients (≥ 18 years) who received remdesivir during their hospitalization at the department of infectious diseases, Klinik Favoriten in Vienna. The data covered the period from July 1, 2021, to April 31, 2022. Patients were divided into two groups based on the timing of remdesivir administration: an early group (0-3 days since symptom onset) and a late group (≥ 4 days since symptom onset). The primary outcome was in-hospital disease progression, assessed using the WHO COVID-19 Clinical Progression Scale (≥ 1 point increase). Multivariable logistic regression, adjusted for age, sex, SARS-CoV‑2 variant, and COVID-19 vaccination status, was used to assess clinical outcomes.
RESULTS: In total 219 patients were included of whom 148 (67.6%) were in the early group and 71 (32.4%) were in the late group. The average age was 66.5 (SD: 18.0) years, 68.9% of the patients were vaccinated, and 72.6% had the Omicron virus variant. Late remdesivir administration was associated with a significantly higher probability of needing high-flow oxygen therapy (OR 2.52, 95% CI 1.40-4.52, p = 0.002) and ICU admission (OR 4.34, 95% CI 1.38-13.67, p = 0.012) after adjusting for confounders. In the late group there was a trend towards a higher risk of clinical worsening (OR 2.13, 95% CI 0.98-4.64, p = 0.056) and need for any oxygen therapy (OR 1.85, 95% CI 0.94-3.64, p = 0.074).
CONCLUSIONS: Compared to patients who received remdesivir within the first 3 days after symptom onset, administering remdesivir after day 3 in hospitalized COVID-19 patients is associated with higher risk for complications, such as the need for high-flow oxygen therapy and ICU admission.
METHODS: We conducted a retrospective analysis using clinical data from consecutively PCR confirmed SARS-CoV‑2 adult patients (≥ 18 years) who received remdesivir during their hospitalization at the department of infectious diseases, Klinik Favoriten in Vienna. The data covered the period from July 1, 2021, to April 31, 2022. Patients were divided into two groups based on the timing of remdesivir administration: an early group (0-3 days since symptom onset) and a late group (≥ 4 days since symptom onset). The primary outcome was in-hospital disease progression, assessed using the WHO COVID-19 Clinical Progression Scale (≥ 1 point increase). Multivariable logistic regression, adjusted for age, sex, SARS-CoV‑2 variant, and COVID-19 vaccination status, was used to assess clinical outcomes.
RESULTS: In total 219 patients were included of whom 148 (67.6%) were in the early group and 71 (32.4%) were in the late group. The average age was 66.5 (SD: 18.0) years, 68.9% of the patients were vaccinated, and 72.6% had the Omicron virus variant. Late remdesivir administration was associated with a significantly higher probability of needing high-flow oxygen therapy (OR 2.52, 95% CI 1.40-4.52, p = 0.002) and ICU admission (OR 4.34, 95% CI 1.38-13.67, p = 0.012) after adjusting for confounders. In the late group there was a trend towards a higher risk of clinical worsening (OR 2.13, 95% CI 0.98-4.64, p = 0.056) and need for any oxygen therapy (OR 1.85, 95% CI 0.94-3.64, p = 0.074).
CONCLUSIONS: Compared to patients who received remdesivir within the first 3 days after symptom onset, administering remdesivir after day 3 in hospitalized COVID-19 patients is associated with higher risk for complications, such as the need for high-flow oxygen therapy and ICU admission.
摘要：
背景：抗病毒药物在控制COVID-19，减少并发症和死亡率方面已变得至关重要。Remdesivir已成为一种有效的治疗药物，用于有疾病进展风险的住院患者，特别是当替代疗法不可行时。而推荐的治疗持续时间的雷米西韦延长至7天的症状发作后，本研究探讨了早期雷米西韦给药对临床结局的影响.
方法：我们使用连续PCR确诊的SARS-CoV-2成年患者（≥18岁）的临床数据进行了回顾性分析，这些患者在传染病科住院期间接受了雷德西韦治疗，在维也纳的KlinikFavoriten。数据涵盖了2021年7月1日至2022年4月31日期间。根据remdesivir给药时间将患者分为两组：早期组（症状发作后0-3天）和晚期组（症状发作后≥4天）。主要结果是院内疾病进展，使用WHOCOVID-19临床进展量表进行评估（增加≥1分）。多变量逻辑回归，根据年龄调整，性别,SARS-CoV-2变体，和COVID-19疫苗接种状况，用于评估临床结果。
结果：共纳入219例患者，其中早期组148例（67.6%），晚期组71例（32.4%）。平均年龄66.5(SD:18.0)岁,68.9%的患者接种了疫苗,72.6%有Omicron病毒变种。调整混杂因素后，晚期使用雷米西韦与需要高流量氧疗(OR2.52,95%CI1.40-4.52,p=0.002)和入住ICU(OR4.34,95%CI1.38-13.67,p=0.012)的概率显著较高相关。在晚期组中，临床恶化的风险有更高的趋势（OR2.13，95％CI0.98-4.64，p=0.056），并且需要任何氧疗（OR1.85，95％CI0.94-3.64，p=0.074）。
结论：与在症状发作后的前3天内接受雷德西韦治疗的患者相比，住院的COVID-19患者在第3天后服用雷德西韦与更高的并发症风险相关，如需要高流量氧疗和ICU入住。
方法：我们使用连续PCR确诊的SARS-CoV-2成年患者（≥18岁）的临床数据进行了回顾性分析，这些患者在传染病科住院期间接受了雷德西韦治疗，在维也纳的KlinikFavoriten。数据涵盖了2021年7月1日至2022年4月31日期间。根据remdesivir给药时间将患者分为两组：早期组（症状发作后0-3天）和晚期组（症状发作后≥4天）。主要结果是院内疾病进展，使用WHOCOVID-19临床进展量表进行评估（增加≥1分）。多变量逻辑回归，根据年龄调整，性别,SARS-CoV-2变体，和COVID-19疫苗接种状况，用于评估临床结果。
结果：共纳入219例患者，其中早期组148例（67.6%），晚期组71例（32.4%）。平均年龄66.5(SD:18.0)岁,68.9%的患者接种了疫苗,72.6%有Omicron病毒变种。调整混杂因素后，晚期使用雷米西韦与需要高流量氧疗(OR2.52,95%CI1.40-4.52,p=0.002)和入住ICU(OR4.34,95%CI1.38-13.67,p=0.012)的概率显著较高相关。在晚期组中，临床恶化的风险有更高的趋势（OR2.13，95％CI0.98-4.64，p=0.056），并且需要任何氧疗（OR1.85，95％CI0.94-3.64，p=0.074）。
结论：与在症状发作后的前3天内接受雷德西韦治疗的患者相比，住院的COVID-19患者在第3天后服用雷德西韦与更高的并发症风险相关，如需要高流量氧疗和ICU入住。
