In:
PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 3 ( 2023-3-24), p. e0283529-
Abstract:
To assess the clinical outcome (death and/or Intensive Care Unit (ICU) admission) based on the time from hospital admission to the administration of anakinra and the possible usefulness of a “simplified” SCOPE score to stratify the risk of worse prognosis in our cohort of patients with moderate/severe SARS-CoV-2 pneumonia, both vaccinated and unvaccinated, that received anakinra and corticosteroids. In addition, the clinical, analytical, and imaging characteristics of patients at admission are described. Methods Retrospective cohort study of 312 patients admitted to Hospital Clínico San Cecilio in Granada for moderate/severe pneumonia caused by SARS-CoV-2 that received anakinra and corticosteroids between March 2020 and January 2022. Clinical and analytical data were collected as well as the patient outcome at 30 and 60 days after admission. Three treatment groups were established according to the time from hospital admission to administration of anakinra: early (1st–2nd day), intermediate (3rd–5th day), and late (after the 5th day). Results The median age was 67.4 years (IQR 22–97 years) and 204 (65.4%) were male. The most common comorbidity was hypertension (58%). The median time from the start of symptoms to anakinra administration was 6 days (IQR 5–10) and the SaFi (SaO 2 /FiO 2 ) was 228 (IQR 71–471). The cure rate was higher in the early-onset anakinra group versus the late-onset group (73% vs 56.6%). The latter had a higher percentage of deaths (27.4%) and a greater number of patients remained hospitalized for a month (16%). On admission, the patients had elevated C-reactive protein (CRP), ferritin, and D-dimer values and decreased total lymphocytes. Analytical improvement was observed at both 72 hours and one month after treatment. 42 (13.5%) required ICU admission, and 23 (7.3%) orotracheal intubation. At 60 days, 221 (70.8%) were discharged, 87 (27.8%) had died and 4 (1.4%) remained hospitalized. The mean dose of anakinra was 1000 mg (100–2600 mg) with differences found between the dose administered and the clinical outcome. There were no differences in the primary outcome based on vaccination. A simplified SCOPE score at the start of anakinra administration was lower in patients with better clinical evolution. Conclusions Early treatment with anakinra and corticosteroids was associated with a better outcome regardless of vaccination status. A simplified SCOPE was found to be a good prognostic tool.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0283529
DOI:
10.1371/journal.pone.0283529.g001
DOI:
10.1371/journal.pone.0283529.g002
DOI:
10.1371/journal.pone.0283529.g003
DOI:
10.1371/journal.pone.0283529.g004
DOI:
10.1371/journal.pone.0283529.g005
DOI:
10.1371/journal.pone.0283529.g006
DOI:
10.1371/journal.pone.0283529.g007
DOI:
10.1371/journal.pone.0283529.t001
DOI:
10.1371/journal.pone.0283529.t002
DOI:
10.1371/journal.pone.0283529.t003
DOI:
10.1371/journal.pone.0283529.t004
DOI:
10.1371/journal.pone.0283529.s001
DOI:
10.1371/journal.pone.0283529.s002
DOI:
10.1371/journal.pone.0283529.r001
DOI:
10.1371/journal.pone.0283529.r002
DOI:
10.1371/journal.pone.0283529.r003
DOI:
10.1371/journal.pone.0283529.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2023
detail.hit.zdb_id:
2267670-3
Permalink