Bradycardia and Outcomes in COVID-19 Patients on Remdesivir: A Multicenter Retrospective Study
Bibliographic record
Abstract
Background: Antiviral agents, such as remdesivir, have shown promising results in helping reduce the morbidity and healthcare burden of coronavirus disease 2019 (COVID-19) in hospitalized patients. However, many studies have reported a relationship between remdesivir and bradycardia. Therefore, this study aimed to analyze the relationship between bradycardia and outcomes in patients on remdesivir. Methods: We conducted a retrospective study of 2,935 consecutive COVID-19 patients admitted to seven hospitals in Southern California in the United States between January 2020 and August 2021. First, we did a backward logistic regression to analyze the relationship between remdesivir use and other independent variables. Finally, we did a backward selection Cox multivariate regression analysis on the sub-group of patients who received remdesivir to evaluate the mortality risk in bradycardic patients on remdesivir. Results: The mean age of the study population was 61.5 years; 56% were males, 44% received remdesivir, and 52% developed bradycardia. Our analysis showed that remdesivir was associated with increased odds of bradycardia (odds ratio (OR): 1.9, P < 0.001). Patients that were on remdesivir in our study were sicker patients with increased odds of having elevated C-reactive protein (CRP) (OR: 1.03, P < 0.001), elevated white blood cell (WBC) on admission (OR: 1.06, P < 0.001), and increased length of hospital stay (OR: 1.02, P = 0.002). However, remdesivir was associated with decreased odds of mechanical ventilation (OR: 0.53, P < 0.001). In the sub-group analysis of patients that received remdesivir, bradycardia was associated with reduced mortality risk (hazard ratio (HR): 0.69, P = 0.002). Conclusions: Our study showed that remdesivir was associated with bradycardia in COVID-19 patients. However, it decreased the odds of being on a ventilator, even in patients with increased inflammatory markers on admission. Furthermore, patients on remdesivir that developed bradycardia had no increased risk of death. Clinicians should not withhold remdesivir from patients at risk of developing bradycardia because bradycardia in such patients was not found to worsen the clinical outcome.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.185 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".