From the Guidelines
The study by Basoulis et al. (2025) has significant limitations, primarily due to its small sample size, limited geographic scope, and retrospective design, which restricts its generalizability and introduces potential biases, as noted in studies discussing the challenges of conducting clinical trials during the COVID-19 pandemic 1. The primary criticism of the study is its small sample size and limited geographic scope, covering only seven hospitals in Athens, which restricts generalizability to other populations and healthcare systems.
- The retrospective design introduces potential selection bias and relies heavily on medical records that may have inconsistent documentation practices.
- The study's distinction between deaths "due to" versus "with" COVID-19 is subjective and lacks standardized criteria, making comparisons with other research difficult, a challenge also noted in guidelines for anticoagulation in COVID-19 patients 1.
- Additionally, the study period focuses only on the Omicron variant, preventing analysis of how mortality patterns evolved across different pandemic phases.
- The research also inadequately accounts for vaccination status, comorbidities, and treatment protocols that significantly influence outcomes, as highlighted in recommendations for immunomodulating therapies in COVID-19 treatment 1.
- The absence of a control group limits causal inferences about COVID-19's direct impact on mortality.
- Finally, the study likely underestimates the pandemic's full impact by excluding deaths occurring outside hospital settings and those indirectly related to healthcare system strain during the surge, a consideration important for understanding the broader effects of the pandemic on public health. Given these limitations, it is crucial to interpret the findings of Basoulis et al. (2025) with caution and consider them in the context of other, potentially more robust studies, especially those emphasizing the importance of placebo-controlled trials in establishing treatment efficacy, as discussed in the context of immunomodulating therapies for COVID-19 1.
From the Research
Criticisms of the Study
- The study by Basoulis et al. [no reference provided] may be criticized for its methodology, as it only includes data from seven tertiary-care hospitals in Athens, Greece, which may not be representative of the entire population [no reference provided].
- The study's findings may be limited by the fact that it only examines deaths "due to" COVID-19 and deaths "with" COVID-19, without considering other factors that may have contributed to the deaths [no reference provided].
- The study's results may be influenced by the Omicron variant surge, which may have affected the severity and mortality of COVID-19 cases [no reference provided].
Comparison with Other Studies
- A study by 2 found that remdesivir, dexamethasone, and tocilizumab have demonstrated mortality benefits in large, randomized controlled trials, which may be relevant to the study by Basoulis et al.
- A systematic review and network meta-analysis by 3 found that nirmatrelvir/ritonavir and sotrovimab were associated with lower risks of mortality and hospitalization compared to nonuser controls, which may be relevant to the study by Basoulis et al.
- A study by 4 found that higher doses of corticosteroids may lead to a poorer prognosis for severe and critical COVID-19 patients with Omicron variant infection, which may be relevant to the study by Basoulis et al.
Limitations of the Study
- The study by Basoulis et al. may be limited by its retrospective design, which may be subject to biases and confounding variables [no reference provided].
- The study's sample size may be limited, which may affect the generalizability of the results [no reference provided].
- The study's findings may be influenced by the specific population and setting of the study, which may not be representative of other populations and settings [no reference provided].