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Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital

Soto et al., PLOS ONE, doi:10.1371/journal.pone.0264789
Mar 2022  
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Mortality -41% Improvement Relative Risk Ivermectin for COVID-19  Soto et al.  LATE TREATMENT Is late treatment with ivermectin beneficial for COVID-19? Retrospective 1,418 patients in Peru (April - August 2020) Data inconsistency, significant unadjusted confounding by indication/time likely c19ivm.org Soto et al., PLOS ONE, March 2022 Favorsivermectin Favorscontrol 0 0.5 1 1.5 2+
Ivermectin for COVID-19
4th treatment shown to reduce risk in August 2020
 
*, now with p < 0.00000000001 from 105 studies, recognized in 23 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,800+ studies for 95 treatments. c19ivm.org
Retrospective 1,418 very late stage (46% mortality) patients in Peru, showing higher mortality with ivermectin. There is strong confounding by indication, for example 48% of patients with baseline SpO2 <70% were treated compared with 22% for SpO2 >95%. The more extreme Cox result compared to the event counts also supports this. There may also be significant confounding by time with SOC changing substantially over the first few months of the pandemic. Patients may overlap with those in1. The results in the table and text do not match.
This is the 81st of 105 COVID-19 controlled studies for ivermectin, which collectively show efficacy with p<0.0000000001 (1 in 774 quintillion).
52 studies are RCTs, which show efficacy with p=0.00000021.
This study is excluded in the after exclusion results of meta analysis: substantial unadjusted confounding by indication likely; substantial confounding by time possible due to significant changes in SOC and treatment propensity near the start of the pandemic.
Study covers HCQ and ivermectin.
risk of death, 41.0% higher, HR 1.41, p = 0.001, treatment 280 of 484 (57.9%), control 374 of 934 (40.0%), adjusted per study, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Soto et al., 2 Mar 2022, retrospective, Peru, peer-reviewed, median age 58.0, 10 authors, study period April 2020 - August 2020, dosage not specified.
This PaperIvermectinAll
Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital
Alonso Soto, Dante M Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, José Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara
PLOS ONE, doi:10.1371/journal.pone.0264789
Objectives To determine the risk factors for in-hospital mortality in patients with COVID-19 from a Peruvian national hospital. Methods Retrospective cohort study of medical records of patients with COVID-19 hospitalized at Hospital Nacional Hipo ´lito Unanue (HNHU) during the months of April to August 2020. The dependent variable was in-hospital mortality. Independent variables included sociodemographic and clinical characteristics, physical examination findings, oxygen saturation (SaO 2 ) at admission, treatment received during hospitalization and laboratory results at admission. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors. Results We included 1418 patients. Median age was 58 years (IQR 47-68 years) and 944 (66.6%) were male. The median length of hospitalization was 7 (4-13) days, and the mortality rate was 46%. The most frequent comorbidities were type 2 diabetes mellitus, hypertension, and obesity. In the adjusted analysis, mortality was associated with age (HR 1.02; 95%CI 1.02-1.03), history of surgery (HR 1.89;, lower oxygen saturation at admission (HR 4.08; CI95% 2.72-8.05 for SaO 2 <70% compared to SaO 2 >94%), the presence of poor general condition (HR 1.81; 95% CI 1.29-2.53), altered state of consciousness (HR 1.58;) and leukocyte levels (HR 1.01; 95%CI 1.00-1. 02). Treatment with ivermectin (HR 1.44; 95%CI 1.18-1.76) and azithromycin (HR 1.25; 95%CI 1.03-1.52) were associated with higher mortality. Treatment with corticosteroids at low to moderate doses was associated with lower mortality (HR 0.56 95%CI 0. 37-0. 86) in comparison to no steroid use.
Supporting information S1 Data. (DTA) Author Contributions Conceptualization: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Andres Alcantara. Data curation: Alonso Soto, Dante M. Quiñones-Laveriano, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara. Formal analysis: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero. Investigation: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara. Methodology: Alonso Soto, Dante M. Quiñones-Laveriano. Software: Alonso Soto. Supervision: Alonso Soto. Validation: Alonso Soto. Visualization: Alonso Soto. Writing -original draft: Alonso Soto, Dante M. Quiñones-Laveriano. Writing -review & editing: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara.
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In the adjusted analysis, mortality was associated with age (HR 1.02; 95%CI ' '1.02–1.03), history of surgery (HR 1.89; 95%CI 1.31–2.74), lower oxygen saturation at ' 'admission (HR 4.08; CI95% 2.72–8.05 for SaO<jats:sub>2</jats:sub>&lt;70% compared to ' 'SaO<jats:sub>2</jats:sub>&gt;94%), the presence of poor general condition (HR 1.81; 95% CI ' '1.29–2.53), altered state of consciousness (HR 1.58; 95%CI 1.18–2.11) and leukocyte levels ' '(HR 1.01; 95%CI 1.00–1. 02). Treatment with ivermectin (HR 1.44; 95%CI 1.18–1.76) and ' 'azithromycin (HR 1.25; 95%CI 1.03–1.52) were associated with higher mortality. Treatment with ' 'corticosteroids at low to moderate doses was associated with lower mortality (HR 0.56 95%CI ' '0. 37–0. 86) in comparison to no steroid use.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec004">\n' '<jats:title>Conclusion</jats:title>\n' '<jats:p>A high mortality was found in our cohort. Low oxygen saturation at admission, age, ' 'and the presence of hematological and biochemical alterations were associated with higher ' 'mortality. The use of hydroxychloroquine, ivermectin or azithromycin was not useful and was ' 'probably associated with unfavorable outcomes. 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Soto', 'year': '2020', 'journal-title': 'Acta Médica Peru.'}], 'container-title': 'PLOS ONE', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://dx.plos.org/10.1371/journal.pone.0264789', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 3, 2]], 'date-time': '2022-03-02T18:52:10Z', 'timestamp': 1646247130000}, 'score': 1, 'resource': {'primary': {'URL': 'https://dx.plos.org/10.1371/journal.pone.0264789'}}, 'subtitle': [], 'editor': [{'given': 'Raffaele', 'family': 'Serra', 'sequence': 'first', 'affiliation': []}], 'short-title': [], 'issued': {'date-parts': [[2022, 3, 2]]}, 'references-count': 46, 'journal-issue': {'issue': '3', 'published-online': {'date-parts': [[2022, 3, 2]]}}, 'URL': 'http://dx.doi.org/10.1371/journal.pone.0264789', 'relation': {}, 'ISSN': ['1932-6203'], 'subject': ['Multidisciplinary'], 'container-title-short': 'PLoS ONE', 'published': {'date-parts': [[2022, 3, 2]]}}
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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