RESULTS
In this study, the mean age of the patients was 57.82 ± 18.23 years, and the mean hospitalization duration was 10.13 ± 6.07 days. In respect of sex, 31 patients (51.7%) were female, without any significant differences between the groups. Table 1 and Table 2 present the clinical and paraclinical characteristics of the study population at admission and discharge showing that CRP (F =9.102, P =0.008), alkaline phosphatase (ALP) (F =7.650, P =0.001), and diff_segment (F =5.156, P =0.007) at discharge were different between the 4 groups in such a way that the atazanavir/ritonavir + HCQ + NAC group had the lowest value concerning CRP. Regarding ALP at discharge, the Kaletra + HCQ + NAC group had the highest value. Furthermore, diff_segment had the highest value in the atazanavir/ritonavir + HCQ + NAC group.
According to the χ2 test, 6 patients in the Kaletra + HCQ group received intravenous immune globulin (IVIG), while the atazanavir/ritonavir + HCQ + NAC group did not receive any IVIG, with the difference constituting statistical significance (P =0.015). Given that the patients were randomly divided into 4 groups, the groups were different with respect to fatigue and anorexia, cardiovascular diseases, and hypertension (Table 3). Regarding binary variables, most cases of fever were reported in the atazanavir/ritonavir + HCQ + NAC group (n =12), most cases of cough in the atazanavir/ritonavir + HCQ + NAC group (n =13) most cases of dyspnea in the atazanavir/ritonavir + HCQ + NAC group (n =13), and most cases of fatigue in the atazanavir/ritonavir + HCQ + NAC group (n =13) and the atazanavir/ritonavir + HCQ group (n =13). Additionally, 12 cases of body aches were reported in the atazanavir/ritonavir + HCQ group, 4 cases of diarrhea in the Kaletra + HCQ group, 7 cases of sore throat in the atazanavir/ritonavir + HCQ+ NAC group, 7 cases of chest discomfort in the Kaletra + HCQ group, 7 cases of headache in the atazanavir/ritonavir + HCQ group, 14 cases of dizziness in the Kaletra + HCQ group + NAC, only 1 case of seizure in the atazanavir/ritonavir + HCQ + NAC group, 6 cases of olfactory dysfunction in the Kaletra + HCQ + NAC group (fewest cases of olfactory dysfunction were observed in the Kaletra + HCQ + NAC group and the atazanavir/ritonavir + HCQ + NAC group), and 5 cases of taste disorders in the Kaletra + HCQ + NAC group.
The administration of dexamethasone, acetaminophen, azithromycin, ceftriaxone, interferon-β, and levofloxacin was not the same across the 4 groups. For instance, 6 patients in each of the atazanavir/ritonavir + HCQ and atazanavir/ritonavir + HCQ + NAC groups received interferon-β (P =.002), indicating that the zero mortality in the atazanavir/ritonavir + HCQ + NAC. Two patients in the Kaletra + HCQ group, 1 patient in the atazanavir/ritonavir + HCQ group, and 1 patient in the Kaletra + HCQ + NAC died; this difference, however, was not statistically significant (χ2 =2.134, P =.896). All the patients in the atazanavir/ritonavir + HCQ + NAC group were discharged in good condition (Table 4).
According to the linear regression model, performed to predict the length of stay at the ICU, the use of IVIG, creatine phosphokinase (CPK) elevation, and ESR decrease were correlated with an increased length of stay at the ICU (Table 5). None of the used drugs had a significant difference regarding mortality (Table 6).
Apropos of improvement in O2 saturation with the 4 types of medicine, the results showed that such improvement with atazanavir/ritonavir + HCQ + NAC (P =.001) and atazanavir/ritonavir + HCQ (P =0.008) was significant insofar as these 2 groups had a high level of O2 saturation after treatment by comparison with the primary O2 saturation level (before intervention) (Table 7). No statistically significant differences in this regard were observed between the 4 groups (P>0.05) (Table 8 and Fig. 2).