6533b861fe1ef96bd12c5012
RESEARCH PRODUCT
Disentangling the Association of Hydroxychloroquine Treatment with Mortality in Covid-19 Hospitalized Patients through Hierarchical Clustering
Anna SabenaGabriele GiulianoRaffaele BrunoFrancesco CacciatoreCarlo TortiSilvia MarongiuGloria MaccagniClaudia MarottaGiovanni LarizzaFrancesco PetriMassimo MapelliGiulio MarescaGiulia RighettiAlessandra VergoriIlaria RossiDamiano D'ardesNicola Schiano MorielloIvan GentileEnrica TamburriniLuca AielloPiergiuseppe AgostoniAntonio CascioJovana MilicCarlo Andrea PivatoAgostino VirdisStefano MaitanFrancesco CannataSimona CostanzoCarlo SignorelliFranco MastroianniFederica MagniCrizia ColomboGiulio G. StefaniniLucia CaianoFrancesca CrostaLorenzo MarraGiuseppe PattiKatleen De Gaetano DonatiValerio LangellaAnnalisa CrisettiFilippo AucellaAntonella CingolaniSalinaro FrancescoAugusto Di CastelnuovoGiacomo CastiglioneAlessandro GialluisiAnna OdoneCristina MussiniSamir Al MoghaziLorenzo BlandiMaria MussoMarialaura BonaccioRaffaele De CaterinaMarco OlivieriRoberto CaudaEmanuela PasiArturo CicculloStefano PerliniClaudia ColombaAntonella PalimoddeGianpiero D'offiziMarco G. MennuniWalter AgenoRaffaele PesaventoRosa ManueleRoberta MussinelliVincenzo SangiovanniPaolo BonfantiAndrea AntinoriFrancesco GianfagnaAndrea RognoniLaura ScorzoliniRiccardo MaragnaRossella MarcucciFilippo MinutoloArmando LeoneGiustino ParrutiLicia IacovielloLorenzo MenicantiSandro MancarellaRosa ArborettiGreta BarbieriCarlo GaudiosiMarco RossatoClaudia RavagliaAndrea VianelloMarianna RossiEmauele GrazianiMartina BarchittaGiovanni GuaraldiEnrico Maria TrecarichiGian Battista DanziFrancesco CipolloneCarlo SanroccoMarco VincetiMarco VincetiFrancesca SantilliMarianna MeschiariGabriella GuarnieriAntonella AgodiRoberto VettorRaffaella SgarigliaIlaria MyFrancesco Di GennaroAlessandro MengozziGiuseppe Di TanoLaura CarrozziMichele SpinicciVenerino PolettiPaola SimeoneNausicaa BerselliFrancesco Maria Fuscosubject
MaleMedicine (General)Antimalarial030204 cardiovascular system & hematologySeverity of Illness IndexHospital Mortality.0302 clinical medicineRetrospective Studie80 and overCluster Analysis030212 general & internal medicineHospital MortalityAged; Aged 80 and over; Antimalarials; COVID-19; Cluster Analysis; Female; Humans; Hydroxychloroquine; Italy; Male; Middle Aged; Retrospective Studies; SARS-CoV-2; Severity of Illness Index; Treatment Outcome; Hospital MortalityAged 80 and overMiddle AgedTreatment OutcomeItalyFemaleBiotechnologymedicine.drugResearch ArticleHydroxychloroquinemedicine.medical_specialtyArticle SubjectBiomedical EngineeringRenal functionHealth Informatics03 medical and health sciencesAntimalarialsR5-920Internal medicineDiabetes mellitusSeverity of illnessmedicineMedical technologyHumansR855-855.5AgedRetrospective StudiesCluster Analysibusiness.industrySARS-CoV-2CancerCOVID-19Retrospective cohort studyHydroxychloroquinemedicine.diseaseObesityCOVID-19 Drug TreatmentSurgeryObservational studybusinessdescription
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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-01-01 | Journal of Healthcare Engineering |