Effect of Therapeutic Agents on Outcome of Different level of Progression of COVID-19 Infection in Pakistani Population

Background: Cytopathic effects of virus and cytokine release syndrome complicate acute respiratory distress syndrome and ultimately leads to multi-organ failure which can eventually culminate to mortality in COVID-19 patients. Many therapeutic agents have been tried from different aspects in desperation to control the unrestricted spread of virus, although the evidence of benefit was sparse. Material and method: It is a retrospective cohort study of the treatment given to the patients admitted at Indus hospital Karachi from March 2020 to September 2020. In this study, we aim to evaluate therapeutic response of the treatment recommended in COVID-19 patients which included Methylprednisolone, Remdesivir, Tocilizumab and Hydroxychloroquine. We categorized the patients according to the CALL score (Comorbid, Age, Lymphocyte count, LDH) in to mild, moderate and at severe risk of progression of disease. Results: Overall, out of 704 patients, 238(33.8%) patients died while 466(66.2%) survived. Least deaths were observed in low-risk group 30(12.6%) as compared to intermediate group 98(41.2%) and high risk patients 110(46.2%). In low, intermediate, and high risk groups, patients who didn’t receive treatment showed better recovery [61(95.3%) vs 90(76.9%)], [59(75.6%) vs 137(63.4)] and [31(63.3%) vs 88(48.9%)] respectively. Similarly, in Remdesivir group, the patients who did not receive the treatment showed good outcome [(132 (86.6%) vs15 (62.5%)], [164 (69.8%) vs 32 (54.2%)] and [103 (56.3%) vs 16 (34.8%)]. In the same way Tocilizumab [136 (86.6%) vs 15(62.5%)], [166 (72.5%) vs 30 (46.2%)] and [103 (57.9%) vs 16 (31.4%)]. Lastly, Hydroxychloroquine [133 (86.4%) vs 18 (66.7%)], [169 (67.3%) vs27 (62.8%)] and [102 (52%) vs17 (51.5%)]. Over none of the treatment showed any beneficial effect on hospital stay and mortality. Conclusion: Therapeutic option for treatment is limited and that these drugs as currently used should no longer be considered viable treatment options for COVID-19. There is need of research in developing new therapeutic options.