Skip to main content
ISTH 2023 Main banner
Back

    Oral Communication

    COVID

    Clinical Outcomes in COVID-19

    OC 29.4 - Impact of symptom duration on clinical outcomes in hospitalized, non-critically ill patients with COVID-19; secondary analysis of an international multi-platform RCT

    Sunday, June 25, 2023
    15:30 – 15:45 ET
    Room: 710A
    Session Available As: On-Demand
    Background: COVID-19 causes a spectrum of disease ranging from asymptomatic infection to critical illness and death. In the ATTACC/ACTIV-4a/REMAP-CAP multi-platform RCT, therapeutic-dose heparin improved survival without ICU-level organ support in non-critically ill patients hospitalized for COVID-19. It is unknown whether patients who had COVID-19 symptoms for longer before hospitalization are at greater risk of progression to ICU-level organ support or death, or if there is a differential effect of therapeutic-dose heparin by symptom-days.

    Aims: To explore the impact of COVID-19 symptom-days prior to hospitalization on survival without ICU-level organ support and the impact of symptom-days on the treatment effect of therapeutic-dose heparin.

    Methods: We included non-critically ill patients randomized in the ATTACC platform. Our primary outcome was a 3-level composite of ICU-level organ support and mortality. Effects were estimated using a proportional odds logistic regression within a Bayesian framework. The effect of symptom-days on therapeutic-dose heparin was evaluated using an interaction term.

    Results: We evaluated 1148 hospitalized, non-critically ill patients of whom 1137 had date of first COVID-19 symptom. Therapeutic-dose heparin and usual care venous thromboprophylaxis were allocated to 638 (56.1%) and 499 (43.9%) patients, respectively. Each additional day of symptoms prior to hospital admission was associated with improved survival without ICU-level organ support (odds ratio [OR] 1.08, 95% credible interval [CrI] 1.04-1.13; posterior probability [Pr] >99.9%). Additional symptom-days were associated with reductions in intubation (Pr 99.5%), mortality at 90 days (Pr 99.5%), combined total thrombosis and death (Pr 98.2%), an increase in hospital-free days (Pr 99.9%), as well as a minor impact on major bleeding (Pr 74.5%). Symptom-days did not modify the treatment effect of therapeutic-dose heparin (OR for interaction 0.98, CrI 0.90-1.05; Pr 27.2%).

    Conclusion(s): Days of COVID-19 symptoms prior to hospitalization were strongly associated with improved survival without ICU-level organ support and did not modify the treatment effect of therapeutic-dose heparin.

    Learning Objectives:

    • Describe how COVID-19 symptom duration affects progression to organ support and mortality in noncritically patients with COVID-19.
    • Describe how COVID-19 symptom duration impacts the treatment effect of therapeutic-dose heparin in noncritically patients with COVID-19.
    • Describe how COVID-19 symptom duration affects clinical outcomes in noncritically patients with COVID-19.