ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Exaggerated inflammatory response with cytokine storm is the hallmark of moderate to severe cases of COVID-19. Several studies have investigated the use of colchicine in COVID-19 due to its anti-inflammatory effects. However, the data regarding its efficacy is still limited and conflicting. This meta-analysis aimed to evaluate the impact of colchicine on mortality and the risk of mechanical ventilation in patients with COVID-19. METHODS: We performed a comprehensive literature search of electronic databases from inception through April 10, 2021, for all peer-reviewed studies that evaluated the clinical benefits of colchicine COVID-19 patients. The primary outcome was the mortality rate. The secondary outcomes included the risk of mechanical ventilation, improvement in systematic inflammation as indicated by changes in serum C-reactive protein, and the risk of adverse events. Pooled risk ratio (RR) and 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-effect model. RESULTS: A total of eight studies involving 926 COVID-19 patients (406 patients received colchicine along with standard-of-care (SOC) therapy and 520 received SOC therapy alone) were included. The mean age was 63.7±14.7 years, and males represented 63.3%. Mortality rate was significantly lower in the colchicine group compared to SOC (RR 0.49 (95% CI: 0.34-0.72, P = 0.0002). However, there was no statistically significant difference in the risk of mechanical ventilation (RR 0.69, 95% CI: 0.31-1.57, P = 0.38). Furthermore, colchicine significantly lowered serum CRP levels (MD -0.40, 95% CI -0.77 to -0.03, P = 0.03). CONCLUSIONS: Our meta-analysis demonstrated that colchicine showed improvement in mortality in COVID-19 patients. However, there was no significant improvement in the risk of mechanical ventilation. CLINICAL IMPLICATIONS: Colchicine may be a potential therapeutic option for COVID-19. Even though the results are encouraging, we need more large-scale RCTs to better characterize the clinical benefits of colchicine in COVID-19 patients. DISCLOSURES: No relevant relationships by Nezam Altorok, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Muhamad Kalifa, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response No relevant relationships by WAHOOD Waseem, source=Web Response
ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Coronavirus disease 2019 (COVID-19) has become a leading cause of mortality globally. Inhaled pulmonary vasodilators, epoprostenol (iEPO) and nitric oxide (iNO), are used as adjunctive therapies for the treatment of refractory hypoxemia in patients with acute respiratory distress syndrome (ARDS). Hypoxemia in COVID-19 patients is mainly caused by ventilation-perfusion mismatch, which might be improved by inhaled pulmonary vasodilators. However, the effects of inhaled pulmonary vasodilator therapy on the clinical outcomes of COVID-19 remain unclear. Therefore, we conducted this meta-analysis to evaluate the impact of pulmonary vasodilators, iNO and iEPO, on the oxygenation parameters in COVID-19 patients with refractory hypoxemia. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through April 24, 2021, to include all published studies. All statistical analyses were performed using the Review Manager software (RevMan 5.3). The weighted mean difference (MD) with corresponding 95% confidence intervals (CI) were calculated using the random-effects model. A P-value <0.05 was considered statistically significant. The primary outcome measure was the change in oxygenation parameter (PaO2/FiO2) pre and post pulmonary vasodilators. RESULTS: A total of seven studies (three and four studies for iEPO and iNO, respectively) involving 211 patients with COVID-19 (140 patients in iEPO group and 71 in iNO) were included. Overall, pulmonary vasodilators showed significant improvement in oxygenation: PaO2/FiO2 (MD: 12.48, 95% CI: 4.51, 20.44, P = 0.002, I2 = 0%). On subgroup analysis, iEPO showed significant improvement in oxygenation: PaO2/FiO2 (MD: 13.39, 95% CI: 2.84, 23.94, P = 0.01, I2 = 0%), however, iNO showed no improvement in oxygenation: PaO2/FiO2 (MD: 12.80, 95% CI: -4.82, 30.42, P = 0.15, I2 = 47%). CONCLUSIONS: Our meta-analysis showed that inhaled epoprostenol improved oxygenation in COVID-19 patients. However, inhaled nitric oxide therapy was not associated with improvement in oxygenation. Major limitation being lack of control arm and adjustment for confounders. Clinical trials are needed to determine the effect of inhaled pulmonary vasodilators on oxygenation parameters and clinical outcomes of COVID-19 patients. CLINICAL IMPLICATIONS: Inhaled pulmonary vasodilators may play a role as rescue therapy in COVID-19 patients with refractory hypoxemia. DISCLOSURES: No relevant relationships by Ziad Abuhelwa, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Dana Ghazaleh, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Rami Musallam, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response
ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become a worldwide pandemic and leading cause morbidity and mortality globally. Due to their immunomodulatory functions, micronutrient supplements such as vitamin D, vitamin C, and zinc have been used for the management of viral illnesses. Furthermore, recent studies have shown low serum vitamin C, vitamin D, and zinc levels in critically ill patients with COVID-19. However, the role of these micronutrients in reducing mortality in patients with COVID-19 remains unclear. Therefore, we conducted this meta-analysis to provide a quantitative assessment of the effect of vitamin D, vitamin C, and zinc on mortality in COVID-19. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through April 24, 2021. All the studies that compared adding micronutrient supplements such as vitamin C, vitamin D, and zinc versus standard-of-care (SOC) in patients with COVID-19 were included. The outcome of interest was the mortality rate. All statistical analyses were performed using the Review Manager software (RevMan 5.3). Pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) were calculated using the random-effects model. A P-value <0.05 was considered statistically significant. RESULTS: Four studies evaluated vitamin C in 390 patients (201 in vitamin C and 189 in SOC). Seven studies assessed vitamin D in 1251 patients (457 in vitamin D and 794 in SOC). Five evaluated zinc in 1506 patients (776 in zinc and 730 in SOC). Both vitamin C (RR 0.60, 95% CI 0.27-1.36, P = 0.22) and vitamin D (RR 0.94, 955 CI 0.46-1.94, P = 0.87) did not significantly reduce mortality. However, zinc was associated with an 33% reduction in mortality compared to SOC (RR 0.67, 95% CI 0.54-0.84, P = 0.0005). CONCLUSIONS: Our meta-analysis demonstrated that zinc reduced mortality in COVID-19 patients. However, vitamin C and D did not show significant improvemnt in mortality. CLINICAL IMPLICATIONS: Micronutrient supplements, especially zinc, may play a role in the treatment of COVID-19. However, it is unclear whether the magnitude of the effects of these micronutrients are clinically meaningful. Further research is needed to better evaluate the utility of these micronutrient supplements in the management of COVID-19. DISCLOSURES: No relevant relationships by Waleed Abdulsattar, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Dana Ghazaleh, source=Web Response No relevant relationships by Waleed Khokher, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Wasef Sayeh, source=Web Response No relevant relationships by Omar Srour, source=Web Response No relevant relationships by Jamie Stewart, source=Web Response