Sara Smuts's scientific contributions

Publications (7)

Article
Importance: The efficacy of antiplatelet therapy in critically ill patients with COVID-19 is uncertain. Objective: To determine whether antiplatelet therapy improves outcomes for critically ill adults with COVID-19. Design, setting, and participants: In an ongoing adaptive platform trial (REMAP-CAP) testing multiple interventions within multip...
Article
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Purpose: Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. Methods: The COVIP study is a prospective internatio...
Article
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Background: health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. Objective: to quantify HRQoL in order to identify areas of interventions. Design: prospective observation study. Setting: admissions to E...
Article
Importance: The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive. Objective: To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. Design, setting, and participants: The ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial f...
Article
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PurposeTo study the efficacy of lopinavir-ritonavir and hydroxychloroquine in critically ill patients with coronavirus disease 2019 (COVID-19).Methods Critically ill adults with COVID-19 were randomized to receive lopinavir-ritonavir, hydroxychloroquine, combination therapy of lopinavir-ritonavir and hydroxychloroquine or no antiviral therapy (cont...
Article
Background The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear. Methods We evaluated tocilizumab and sarilumab in an ongoing international, multifactorial, adaptive platform trial. Adult patients with Covid-19, within 24 hours after starting organ support in the intensiv...
Article
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Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECO...

Citations

... Reduced mortality had reached even higher probability by day 90, but this benefit was accompanied by increased risk of bleeding. 50 These findings are supported by results from a registry on patients post-COVID-19 hospital discharge early on in the pandemic. 55 Therefore, in patients with persistent risk factors for VTE that may include an IMPROVE score of ≥4 or 2-3 with a D-dimer above the upper limit of normal, and without contraindication (e.g., high risk of bleeding, pregnancy, lactation), postdischarge treatment with 10 mg of rivaroxaban daily may be cohort study with more than 300 000 patients. ...
... The REMAP-CAP trial primary analysis included 1075 critically ill COVID-19 patients who received CCP, 11 patients who received delayed CCP and 904 patients who did not receive CCP. There was no statistically significant difference in in-hospital mortality between the groups [25]. In the RECOVERY trial, 11,558 hospitalized patients were randomized either to receive CCP (5,795) or the standard care (5,763), the conclusion was that high-dose CCP did not improve survival. ...
... Antiviral treatments for COVID-19 were first studied early in the pandemic, primarily with patients admitted to hospital with severe and critical COVID-19. [71][72][73] We posit, however, that antiviral drugs are most useful in nonsevere disease, which is driven by viral proliferation, rather than in severe disease, which is primarily driven by an inflammatory response. 74,75 Previous reviews addressing antiviral drugs for all disease severities have found little -to-no benefit. ...
... So far, systemic corticosteroid administration has been shown to lower the 28-day mortality rate of critically-ill COVID-19 patients [3]. Likewise, interleukin (IL)-6-receptor blockers have been reported to improve outcomes (organ-support-free days and survival) [4]. However, the challenges of implementing the vaccination strategy and the emergence of new viral variants still contribute to the persistently high mortality of patients with SARS-CoV-2-induced ARDS [5]. ...
... However, secondary infection, especially bacterial, could be a concern given the potent immunosuppressive effects of some of these combinations. Lopinavir, often administered with Ritonavir, an agent that increases the half-life of Lopinavir in plasma, acts against the virus directly by blocking viral proteases, but has not demonstrated success in treating hospitalised COVID-19 patients 36,59 . This is consistent with our model's prediction, which suggests that while Lopinavir may be effective at reducing viral replication in the early stages of severe COVID-19 (Fig. 4a), it is not predicted to provide additional benefit in the late stage of the disease ( Supplementary Fig. 4g, h). ...