Your browser doesn't support javascript.
loading
NSAID use and clinical outcomes in COVID-19 patients: A 38-center retrospective cohort study.
Reese, Justin T; Coleman, Ben; Chan, Lauren; Blau, Hannah; Callahan, Tiffany J; Cappelletti, Luca; Fontana, Tommaso; Bradwell, Katie Rebecca; Harris, Nomi L; Casiraghi, Elena; Valentini, Giorgio; Karlebach, Guy; Deer, Rachel; McMurry, Julie A; Haendel, Melissa A; Chute, Christopher G; Pfaff, Emily; Moffitt, Richard; Spratt, Heidi; Singh, Jasvinder; Mungall, Christopher J; Williams, Andrew E; Robinson, Peter N.
Afiliação
  • Reese JT; Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
  • Coleman B; The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA.
  • Chan L; Translational and Integrative Sciences Center, Oregon State University, Corvallis, OR, USA.
  • Blau H; The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA.
  • Callahan TJ; Computational Bioscience, University of Colorado Anschutz Medical Campus, Boulder, CO, USA.
  • Cappelletti L; Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
  • Fontana T; AnacletoLab, Dipartimento di Informatica, Università degli Studi di Milano, Italy.
  • Bradwell KR; AnacletoLab, Dipartimento di Informatica, Università degli Studi di Milano, Italy.
  • Harris NL; Palantir Technologies, Denver, CO, USA.
  • Casiraghi E; Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
  • Valentini G; AnacletoLab, Dipartimento di Informatica, Università degli Studi di Milano, Italy.
  • Karlebach G; CINI, National Laboratory in Artificial Intelligence and Intelligent Systems-AIIS, Roma, Italy.
  • Deer R; AnacletoLab, Dipartimento di Informatica, Università degli Studi di Milano, Italy.
  • McMurry JA; CINI, National Laboratory in Artificial Intelligence and Intelligent Systems-AIIS, Roma, Italy.
  • Haendel MA; The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA.
  • Chute CG; University of Texas Medical Branch, Galveston, TX, USA.
  • Pfaff E; Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
  • Moffitt R; Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
  • Spratt H; Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA.
  • Singh J; North Carolina Translational and Clinical Sciences Institute (NC TraCS), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  • Mungall CJ; Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA.
  • Williams AE; University of Texas Medical Branch, Galveston, TX, USA.
  • Robinson PN; University of Alabama at Birmingham, Birmingham, AL, USA.
medRxiv ; 2021 Dec 22.
Article em En | MEDLINE | ID: mdl-33907758
BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community-acquired pneumonia. Observations shortly after the start of the COVID-19 pandemic in 2020 suggested that ibuprofen was associated with an increased risk of adverse events in COVID-19 patients, but subsequent observational studies failed to demonstrate increased risk and in one case showed reduced risk associated with NSAID use. METHODS: A 38-center retrospective cohort study was performed that leveraged the harmonized, high-granularity electronic health record data of the National COVID Cohort Collaborative. A propensity-matched cohort of COVID-19 inpatients was constructed by matching cases (treated with NSAIDs) and controls (not treated) from 857,061 patients with COVID-19. The primary outcome of interest was COVID-19 severity in hospitalized patients, which was classified as: moderate, severe, or mortality/hospice. Secondary outcomes were acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO), invasive ventilation, and all-cause mortality at any time following COVID-19 diagnosis. RESULTS: Logistic regression showed that NSAID use was not associated with increased COVID-19 severity (OR: 0.57 95% CI: 0.53-0.61). Analysis of secondary outcomes using logistic regression showed that NSAID use was not associated with increased risk of all-cause mortality (OR 0.51 95% CI: 0.47-0.56), invasive ventilation (OR: 0.59 95% CI: 0.55-0.64), AKI (OR: 0.67 95% CI: 0.63-0.72), or ECMO (OR: 0.51 95% CI: 0.36-0.7). In contrast, the odds ratios indicate reduced risk of these outcomes, but our quantitative bias analysis showed E-values of between 1.9 and 3.3 for these associations, indicating that comparatively weak or moderate confounder associations could explain away the observed associations. CONCLUSIONS: Study interpretation is limited by the observational design. Recording of NSAID use may have been incomplete. Our study demonstrates that NSAID use is not associated with increased COVID-19 severity, all-cause mortality, invasive ventilation, AKI, or ECMO in COVID-19 inpatients. A conservative interpretation in light of the quantitative bias analysis is that there is no evidence that NSAID use is associated with risk of increased severity or the other measured outcomes. Our findings are the largest EHR-based analysis of the effect of NSAIDs on outcome in COVID-19 patients to date. Our results confirm and extend analogous findings in previous observational studies using a large cohort of patients drawn from 38 centers in a nationally representative multicenter database.
Palavras-chave

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Idioma: En Revista: MedRxiv Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Idioma: En Revista: MedRxiv Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos