Association between Paxlovid and mortality in severe COVID-19 patients: a retrospective cohort study

Bin Liu; Bo Xie; Li Jiang; Hongli Xia; Chunmei Zhu; Jing Hu; Jing Cai; Yan Zhang; Mingjin Yang; Yanchao Liang

doi:10.3855/jidc.21811

Association between Paxlovid and mortality in severe COVID-19 patients: a retrospective cohort study

Authors

Bin Liu Department of Respiratory and Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, No.116, Changjiang South Road, Tianyuan District, Zhuzhou, Hunan, 412007, China https://orcid.org/0000-0002-0665-0376
Bo Xie Department of Scientific Research, Zhuzhou Central Hospital, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, 412007, Hunan, China
Li Jiang Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong, Chongqing, 400016, China
Hongli Xia Department of General Practice, People’s Hospital of Chongqing Hechuan, Chongqing 401520, China
Chunmei Zhu Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong, Chongqing, 400016, China
Jing Hu Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong, Chongqing, 400016, China
Jing Cai Department of Endocrinology and Metabolism, Chengdu First People's Hospital, No.18, Wanxiang North Road, High-tech Zone, Chengdu, Sichuan, 610000, China
Yan Zhang Digestive System Department, Chengdu Second People’s Hospital, jinjiang District, Chengdu, Sichuan, 610017, China
Mingjin Yang Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong, Chongqing, 400016, China
Yanchao Liang Department of Respiratory and Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, No.116, Changjiang South Road, Tianyuan District, Zhuzhou, Hunan, 412007, China

DOI:

https://doi.org/10.3855/jidc.21811

Keywords:

Paxlovid, COVID-19, severe, mortality

Abstract

Introduction: With limited research on the clinical effectiveness of Paxlovid for hospitalized patients with severe COVID-19, this study aims to assess its impact on clinical outcomes, providing essential insights for patient care.

Methodology: We collected consecutive data from SARS-CoV-2-infected patients at four hospitals between December 2022 and July 2023. We compared patient characteristics, clinical parameters, and treatment regimens between the Paxlovid and control groups. Analyses included crude, multivariable, doubly robust, and propensity score methods to evaluate Paxlovid's impact on 28-day mortality and to identify subgroup interactions.

Results: Of 574 patients treated with Paxlovid, 10.3% died within 28 days, versus 29.9% of 645 untreated patients. Unadjusted analysis showed a significant Paxlovid-associated reduction in 28-day mortality (OR 0.268, 95% CI 0.195-0.369; p < 0.001), sustained after adjustment (adjusted OR 0.298, 95% CI 0.198-0.447; p < 0.001). Paxlovid significantly decreased mortality in patients with infection durations ≤ 5 days (OR 0.401, 95% CI 0.227-0.707, p < 0.001) and > 5 days (OR 0.540, 95% CI 0.309-0.946, p < 0.001). Hospital stays were longer with Paxlovid (median 11 vs. 10 days, p = 0.001), with no significant effect on ICU admission rates.

Conclusions: Our findings suggest that Paxlovid significantly reduces 28-day mortality in severe COVID-19 patients, irrespective of infection duration over 5 days.

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Published

2026-06-30

How to Cite

Liu B, Xie B, Jiang L, Xia H, Zhu C, Hu J, Cai J, Zhang Y, Yang M, Liang Y (2026) Association between Paxlovid and mortality in severe COVID-19 patients: a retrospective cohort study. J Infect Dev Ctries 20:896–903. doi: 10.3855/jidc.21811

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Issue

Vol. 20 No. 06: June 2026

Section

Coronavirus Pandemic

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