Leonard K. Wang , Yong-Fang Kuo , Jordan Westra , Mukaila A. Raji , Mohanad Albayyaa , Joseph Allencherril , Jacques Baillargeon
{"title":"新冠肺炎全国患者队列的匹配分析中心血管药物与不良结果的关联。","authors":"Leonard K. Wang , Yong-Fang Kuo , Jordan Westra , Mukaila A. Raji , Mohanad Albayyaa , Joseph Allencherril , Jacques Baillargeon","doi":"10.1016/j.ajmo.2023.100040","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The use of statins, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs), and anticoagulants may be associated with fewer adverse outcomes in COVID-19 patients.</p></div><div><h3>Methods</h3><p>Nested within a cohort of 800,913 patients diagnosed with COVID-19 between April 1, 2020 and June 24, 2021 from the Optum COVID-19 database, three case-control studies were conducted. Cases—defined as persons who: (1) were hospitalized within 30 days of COVID-19 diagnosis (<em>n</em> = 88,405); (2) were admitted to the intensive care unit (ICU)/received mechanical ventilation during COVID-19 hospitalization (<em>n</em> = 22,147); and (3) died during COVID-19 hospitalization (<em>n</em> = 2300)—were matched 1:1 using demographic/clinical factors with controls randomly selected from a pool of patients who did not experience the case definition/event. Medication use was based on prescription ≤90 days before COVID-19 diagnosis.</p></div><div><h3>Results</h3><p>Statin use was associated with decreased risk of hospitalization (adjusted odds ratio [aOR], 0.72; 95% confidence interval [95% CI], 0.69, 0.75) and ICU admission/mechanical ventilation (aOR, 0.90; 95% CI, 0.84, 0.97). ACEI/ARB use was associated with decreased risk of hospitalization (aOR, 0.67; 95% CI, 0.65, 0.70), ICU admission/mechanical ventilation (aOR, 0.92; 95% CI, 0.86, 0.99), and death (aOR, 0.60; 95% CI, 0.47, 0.78). Anticoagulant use was associated with decreased risk of hospitalization (aOR, 0.94; 95% CI, 0.89, 0.99) and death (aOR, 0.56; 95% CI, 0.41, 0.77). Interaction effects—in the model predicting hospitalization—were statistically significant for statins and ACEI/ARBs (<em>P</em> < .0001), statins and anticoagulants (<em>P</em> = .003), ACEI/ARBs and anticoagulants (<em>P</em> < .0001). An interaction effect—in the model predicting ventilator use/ICU—was statistically significant for statins and ACEI/ARBs (<em>P</em> = .002).</p></div><div><h3>Conclusions</h3><p>Statins, ACEI/ARBs, and anticoagulants were associated with decreased risks of the adverse outcomes under study. These findings may provide clinically relevant information regarding potential treatment for patients with COVID-19.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"9 ","pages":"Article 100040"},"PeriodicalIF":0.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10032048/pdf/","citationCount":"3","resultStr":"{\"title\":\"Association of Cardiovascular Medications With Adverse Outcomes in a Matched Analysis of a National Cohort of Patients With COVID-19\",\"authors\":\"Leonard K. Wang , Yong-Fang Kuo , Jordan Westra , Mukaila A. Raji , Mohanad Albayyaa , Joseph Allencherril , Jacques Baillargeon\",\"doi\":\"10.1016/j.ajmo.2023.100040\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The use of statins, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs), and anticoagulants may be associated with fewer adverse outcomes in COVID-19 patients.</p></div><div><h3>Methods</h3><p>Nested within a cohort of 800,913 patients diagnosed with COVID-19 between April 1, 2020 and June 24, 2021 from the Optum COVID-19 database, three case-control studies were conducted. Cases—defined as persons who: (1) were hospitalized within 30 days of COVID-19 diagnosis (<em>n</em> = 88,405); (2) were admitted to the intensive care unit (ICU)/received mechanical ventilation during COVID-19 hospitalization (<em>n</em> = 22,147); and (3) died during COVID-19 hospitalization (<em>n</em> = 2300)—were matched 1:1 using demographic/clinical factors with controls randomly selected from a pool of patients who did not experience the case definition/event. Medication use was based on prescription ≤90 days before COVID-19 diagnosis.</p></div><div><h3>Results</h3><p>Statin use was associated with decreased risk of hospitalization (adjusted odds ratio [aOR], 0.72; 95% confidence interval [95% CI], 0.69, 0.75) and ICU admission/mechanical ventilation (aOR, 0.90; 95% CI, 0.84, 0.97). ACEI/ARB use was associated with decreased risk of hospitalization (aOR, 0.67; 95% CI, 0.65, 0.70), ICU admission/mechanical ventilation (aOR, 0.92; 95% CI, 0.86, 0.99), and death (aOR, 0.60; 95% CI, 0.47, 0.78). Anticoagulant use was associated with decreased risk of hospitalization (aOR, 0.94; 95% CI, 0.89, 0.99) and death (aOR, 0.56; 95% CI, 0.41, 0.77). Interaction effects—in the model predicting hospitalization—were statistically significant for statins and ACEI/ARBs (<em>P</em> < .0001), statins and anticoagulants (<em>P</em> = .003), ACEI/ARBs and anticoagulants (<em>P</em> < .0001). An interaction effect—in the model predicting ventilator use/ICU—was statistically significant for statins and ACEI/ARBs (<em>P</em> = .002).</p></div><div><h3>Conclusions</h3><p>Statins, ACEI/ARBs, and anticoagulants were associated with decreased risks of the adverse outcomes under study. These findings may provide clinically relevant information regarding potential treatment for patients with COVID-19.</p></div>\",\"PeriodicalId\":72168,\"journal\":{\"name\":\"American journal of medicine open\",\"volume\":\"9 \",\"pages\":\"Article 100040\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10032048/pdf/\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of medicine open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2667036423000109\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of medicine open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2667036423000109","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Association of Cardiovascular Medications With Adverse Outcomes in a Matched Analysis of a National Cohort of Patients With COVID-19
Background
The use of statins, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs), and anticoagulants may be associated with fewer adverse outcomes in COVID-19 patients.
Methods
Nested within a cohort of 800,913 patients diagnosed with COVID-19 between April 1, 2020 and June 24, 2021 from the Optum COVID-19 database, three case-control studies were conducted. Cases—defined as persons who: (1) were hospitalized within 30 days of COVID-19 diagnosis (n = 88,405); (2) were admitted to the intensive care unit (ICU)/received mechanical ventilation during COVID-19 hospitalization (n = 22,147); and (3) died during COVID-19 hospitalization (n = 2300)—were matched 1:1 using demographic/clinical factors with controls randomly selected from a pool of patients who did not experience the case definition/event. Medication use was based on prescription ≤90 days before COVID-19 diagnosis.
Results
Statin use was associated with decreased risk of hospitalization (adjusted odds ratio [aOR], 0.72; 95% confidence interval [95% CI], 0.69, 0.75) and ICU admission/mechanical ventilation (aOR, 0.90; 95% CI, 0.84, 0.97). ACEI/ARB use was associated with decreased risk of hospitalization (aOR, 0.67; 95% CI, 0.65, 0.70), ICU admission/mechanical ventilation (aOR, 0.92; 95% CI, 0.86, 0.99), and death (aOR, 0.60; 95% CI, 0.47, 0.78). Anticoagulant use was associated with decreased risk of hospitalization (aOR, 0.94; 95% CI, 0.89, 0.99) and death (aOR, 0.56; 95% CI, 0.41, 0.77). Interaction effects—in the model predicting hospitalization—were statistically significant for statins and ACEI/ARBs (P < .0001), statins and anticoagulants (P = .003), ACEI/ARBs and anticoagulants (P < .0001). An interaction effect—in the model predicting ventilator use/ICU—was statistically significant for statins and ACEI/ARBs (P = .002).
Conclusions
Statins, ACEI/ARBs, and anticoagulants were associated with decreased risks of the adverse outcomes under study. These findings may provide clinically relevant information regarding potential treatment for patients with COVID-19.
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