目的:在本研究中,我们旨在探讨paxlovid在临床上降低COVID-19患者死亡率的疗效,尤其是paxlovid是否能改变这些重症和危重患者的死亡风险.
方法:我们的回顾性队列研究是针对患者的病历进行的,连续入住重庆五家医院的COVID-19,中国,2022年12月8日至2023年1月20日。根据患者在住院期间是否接受了Paxlovid,患者分为paxlovid组和非paxlovid组。在我们的研究中,我们使用1:1比率倾向评分匹配(PSM)来调整混杂因素和组间差异。采用SPSS23.0进行统计学分析。这两组28天死亡率的差异及其影响因素是我们关注的主要结果。
结果:我们的研究队列包括1018例患者。使用1:1比例的PSM,paxlovid组和非paxlovid组各有237例患者.结果显示,使用paxlovid的患者在PSM之前(OR0.594,95%CI0.385-0.917,p=0.019)或PSM之后(OR0.458,95%CI0.272-0.774,p=0.003)的总体人群中28天死亡率较低。同时,在严重亚组中,它显示了类似的发现。经过Paxlovid治疗,它显示严重亚组在PSM前28天死亡率显著降低(28%vs.41%,p=0.008)和PSM后(19%vs.32%,p=0.007)。
结论:Paxlovid可显著降低总体人群和严重亚组患者28天死亡的风险。这项研究区分了严重的COVID-19亚组患者,他们从paxlovid治疗中受益更多。
OBJECTIVE: In this study, we aim to explore the efficacy of paxlovid on reducing mortality of COVID-19 patients in clinical setting, especially whether paxlovid modifies the risk of death in these severe and critical patients.
METHODS: Our retrospective cohort study was conducted on the medical records of patients, consecutively admitted for COVID-19 to five hospitals in Chongqing,
China from Dec 8, 2022 to Jan 20, 2023. Based on whether patients received paxlovid during their hospitalization, patients were grouped as paxlovid group and non-paxlovid group. We used 1:1 ratio propensity score matching (PSM) in our study to adjust for confounding factors and differences between groups. Statistical analysis were performed by SPSS 23.0. The differences in 28-day mortality between these two groups and its influencing factors were the main results we focused on.
RESULTS: There were 1018 patients included in our study cohort. With 1:1 ratio PSM, each of the paxlovid group and non-paxlovid group included 237 patients. The results showed that patients using paxlovid have a lower 28-day mortality in overall population either before PSM (OR 0.594, 95% CI 0.385-0.917, p = 0.019) or after PSM (OR 0.458, 95% CI 0.272-0.774, p = 0.003) with multivariable adjusted logistic regression models. Meanwhile, in severe subgroup, it showed similar findings.With paxlovid treatment, it showed a significantly lower 28-day mortality in severe subgroup both before PSM (28% vs.41%, p = 0.008) and after PSM (19% vs.32%, p = 0.007).
CONCLUSIONS: Paxlovid can significantly reduce the risk of 28-day mortality in overall population and severe subgroup patients.This study distinguished the severe subgroup patients with COVID-19 who benefit more from paxlovid treatment.