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Disentangling the Association of Hydroxychloroquine Treatment with Mortality in Covid-19 Hospitalized Patients through Hierarchical Clustering
- Source :
- Journal of Healthcare Engineering, Journal of Healthcare Engineering, Vol 2021 (2021)
- Publication Year :
- 2021
- Publisher :
- Hindawi, 2021.
-
Abstract
- The efficacy of hydroxychloroquine (HCQ) in treating SARS-CoV-2 infection is harshly debated, with observational and experimental studies reporting contrasting results. To clarify the role of HCQ in Covid-19 patients, we carried out a retrospective observational study of 4,396 unselected patients hospitalized for Covid-19 in Italy (February–May 2020). Patients’ characteristics were collected at entry, including age, sex, obesity, smoking status, blood parameters, history of diabetes, cancer, cardiovascular and chronic pulmonary diseases, and medications in use. These were used to identify subtypes of patients with similar characteristics through hierarchical clustering based on Gower distance. Using multivariable Cox regressions, these clusters were then tested for association with mortality and modification of effect by treatment with HCQ. We identified two clusters, one of 3,913 younger patients with lower circulating inflammation levels and better renal function, and one of 483 generally older and more comorbid subjects, more prevalently men and smokers. The latter group was at increased death risk adjusted by HCQ (HR[CI95%] = 3.80[3.08-4.67]), while HCQ showed an independent inverse association (0.51[0.43-0.61]), as well as a significant influence of cluster∗HCQ interaction ( p < 0.001 ). This was driven by a differential association of HCQ with mortality between the high (0.89[0.65-1.22]) and the low risk cluster (0.46[0.39-0.54]). These effects survived adjustments for additional medications in use and were concordant with associations with disease severity and outcome. These findings suggest a particularly beneficial effect of HCQ within low risk Covid-19 patients and may contribute to clarifying the current controversy on HCQ efficacy in Covid-19 treatment.
- Subjects :
- Male
Medicine (General)
Antimalarial
030204 cardiovascular system & hematology
Severity of Illness Index
Hospital Mortality
0302 clinical medicine
Retrospective Studie
80 and over
Cluster Analysis
030212 general & internal medicine
Aged
Aged, 80 and over
Antimalarials
COVID-19
Female
Humans
Hydroxychloroquine
Italy
Middle Aged
Retrospective Studies
SARS-CoV-2
Treatment Outcome
Biotechnology
medicine.drug
Research Article
medicine.medical_specialty
Article Subject
Biomedical Engineering
Renal function
Health Informatics
03 medical and health sciences
R5-920
Internal medicine
Diabetes mellitus
Severity of illness
medicine
Medical technology
R855-855.5
Cluster Analysi
business.industry
Cancer
Retrospective cohort study
medicine.disease
Obesity
COVID-19 Drug Treatment
Surgery
Observational study
business
Subjects
Details
- Language :
- English
- ISSN :
- 20402295
- Database :
- OpenAIRE
- Journal :
- Journal of Healthcare Engineering
- Accession number :
- edsair.doi.dedup.....c4a7693ac510861fae4e85b270c73f25
- Full Text :
- https://doi.org/10.1155/2021/5556207