Background COVID-19 remains a major public health concern, with continued resurgences of cases and substantial risk of mortality for hospitalized patients. Remdesivir has become standard-of-care for hospitalized COVID-19 patients. Given the continued evolution of the disease, clinical management relies on evidence from the current endemic period. Methods Using the PINC AI Healthcare database, effectiveness of remdesivir was evaluated among adults hospitalized with a primary diagnosis of COVID-19 between December 2021 and February 2024. Three cohorts were analysed: adults, elderly (≥65 years), and those with documented COVID-19 pneumonia. Analyses were stratified by oxygen requirements. Patients receiving remdesivir were matched to those not receiving remdesivir using propensity score matching. Cox proportional hazards models were used to examine in-hospital mortality. Results 169,965 adults hospitalized for COVID-19 were included, of which 94,129 (55.4%) initiated remdesivir in the first two days of hospitalization. Remdesivir was associated with a significantly lower mortality rate as compared to no remdesivir among patients with no supplemental oxygen charges (NSOc) (aHR [95% CI]: 14-day, 0.75 [0.69-0.82]; 28-day, 0.77 [0.72-0.83]) and among those with supplemental oxygen charges (SOc): 14-day, 0.76 [0.72-0.81]; 28-day, 0.79 [0.74-0.83]) (p<0.0001, for all). Similar findings were observed for elderly patients and those hospitalized with COVID-19 pneumonia. Conclusions This evidence builds on learnings from randomized controlled trials from the pandemic era to inform clinical practices. Remdesivir was associated with significant reduction in mortality for hospitalized patients including the elderly and those with COVID-19 pneumonia.

中文翻译：

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使用瑞德西韦治疗因 COVID-19 住院的弱势患者的管理：美国医院死亡率的回顾性比较有效性研究


背景 COVID-19 仍然是一个主要的公共卫生问题，病例持续卷土重来，住院患者面临巨大的死亡风险。瑞德西韦已成为 COVID-19 住院患者的标准护理。鉴于疾病的持续发展，临床管理依赖于当前流行时期的证据。方法 使用 PINC AI Healthcare 数据库，在 2021 年 12 月至 2024 年 2 月期间因初步诊断为 COVID-19 而住院的成年人中评估瑞德西韦的有效性。分析了三个队列：成人、老年人 （≥65 岁） 和有记录的 COVID-19 肺炎患者。按氧气需求对分析进行分层。使用倾向评分匹配将接受 remdesivir 的患者与未接受 remdesivir 的患者进行匹配。使用 Cox 比例风险模型检查院内死亡率。结果 纳入 169,965 例因 COVID-19 住院的成人，其中 94,129 例 （55.4%） 在住院前两天开始使用瑞德西韦。与不使用瑞德西韦相比，瑞德西韦在无补充氧疗费用 （NSOc） 患者中的死亡率显著降低 （aHR [95% CI]： 14 天，0.75 [0.69-0.82];28 天，0.77 [0.72-0.83]） 和在补充氧气 （SOc） 患者中：14 天，0.76 [0.72-0.81];28 天，0.79 [0.74-0.83]）（p<0.0001，全部）。在老年患者和因 COVID-19 肺炎住院的患者中也观察到类似的发现。结论 该证据建立在大流行时代的随机对照试验的经验之上，为临床实践提供信息。瑞德西韦与包括老年人和 COVID-19 肺炎患者在内的住院患者死亡率的显着降低有关。