Trying to Find the Answer for Two Questions in Patients with COVID-19: 1. Is pulmonary infiltrate of COVID-19 infective or inflammatory in nature (Pneumonia or Pneumonitis)? 2. Is Hydroxychloroquine plus Azithromycin or Favipiravir plus Dexamethasone more effective in the COVID-19 treatment?

  1. Adem Dirican
  2. Tugce Uzar
  3. Irem Karaman
  4. Aziz Uluisik
  5. Sevket Ozkaya

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Abstract

Background

During the current pandemic, a great effort is made to understand the COVID-19 and find an effective treatment. As of 17 August 2020, there is no specific drug or biologic agent which have been approved by the FDA for the prevention or treatment of COVID-19.

Methods

We retrospectively analyzed the clinical and radiological findings of 211 COVID-19 in-patients that were treated between March - August 2020. Confirmation of a COVID-19 diagnosis was made according to a positive RT-PCR result with a consistent high-resolution-CT (HRCT) finding. Radiological images and the rate of clinical response of patients were investigated.

Result

While 128 patients (58.7) did not develop pneumonia, the mild, moderate and severe pneumonia ratios were 28(13.2%), 31(18.7%) and 27(22.9%). 72 patients (34.1%) whose PCR tests were positive did not show any symptom and they were followed in isolation without treatment. 52 patients (24.6%) received hydroxychloroquine plus azithromycin, 57 patients (27%) received favipiravir and 30 patients (14.2%) received favipiravir plus dexamethasone as the first line of treatment. 63.1% of pneumonia patients who received hydroxychloroquine plus azithyromycine, 28.3% of patients who received favipiravir and 10% of patients who received favipiravir plus dexamethasone showed a failure of treatment.

Conclusion

The pulmonary infiltrates of COVID-19 are not infective; therefore, the characteristic of the disease should be described as COVID-19 pneumonitis instead of pneumonia. The favipiravir plus dexamethasone seems to be the only drug combination to achieve the improvement of radiological presentation and clinical symptoms in COVID-19 pneumonia patients.

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  1. ScreenIT

    SciScore for 10.1101/2020.08.25.20181388: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the Institutional Review Board of SB (IRB No. 2020-07-21T10-25-53) and performed in accordance with the principles of the Declaration of Helsinki.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All of the analysis was performed using SPSS Version 22.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, one limitation of this study includes a lack of pathological investigation of patients due to the inability to take a biopsy during clinical practice due to the circumstances during the pandemic. Segmental small pulmonary vessel enlargement on chest CT has been stated as a unique feature associated with COVID-19, different from other viral or bacterial pneumonia findings on chest CT (21). Lang et. al also stated that medium to small vessel dilatations are not confined to areas of the diseased lung, and often involve subpleural distal vessels, suggesting a diffuse vascular process (22). One theory behind those findings is the possibility of COVID-19-induced secondary pulmonary vasculitis that is responsible for vascular changes and abundance of pulmonary parenchymal ground-glass opacification (21, 22). The vascular dilatations seen in ground glass-opacities of COVID-19 can be a good indication to differentiate COVID-19 from other etiologies of ground-glass opacities, as seen in our cases (Figure 7 and 8). Those vascular dilatations might indicate that COVID-19 starts as vasculitis and progresses to the perivascular inflammation. It is not clear if it is an immune-complex vasculitis or not, and further pathological examinations must be done to have a clear result. This study has some limitations. Since this study was not designed to compare the two groups at the same time but rather to compare the outcomes of two different groups of patients treated at different times ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.08.25.20181388v2 on medRxiv
  3. Version published to 10.1101/2020.08.25.20181388v1 on medRxiv