Impact of proton pump inhibitors on the in-hospital outcome of COVID-19 patients: a retrospective study.

Background: Coronavirus disease 2019 (COVID-19) has triggered a global public health crisis. Proton pump inhibitors (PPIs) are one of the most commonly prescribed drugs. However, the effect of PPIs on the clinical outcomes of COVID-19 patients remains unclear. Methods: All COVID-19 patients admitted to the Wuhan Huoshenshan Hospital from February 2020 to April 2020 were retrospectively collected. Patients were divided into PPIs and non-PPIs groups. Logistic regression analyses were performed to explore the effects of PPIs on the outcomes of COVID-19 patients, including transfer to intensive care unit, mechanical ventilation, and death. Subgroup analyses were performed according to the presence of upper gastrointestinal symptoms potentially associated with acid and the routes, types, median total dosage, and duration of PPIs. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Of the 3024 COVID-19 patients included, 694 and 2330 were in PPIs and non-PPIs groups, respectively. Univariate logistic regression analysis showed that PPIs significantly increased the risk of reaching the composite endpoint in COVID-19 patients (OR = 10.23, 95% CI = 6.90-15.16, p < 0.001). After adjusting for age, sex, comorbidities, other medications, and severe/critical COVID-19, PPIs were independently associated with an increased risk of reaching the composite endpoint (OR = 7.00, 95% CI = 4.57-10.71, p < 0.001). This association remained significant in patients with upper gastrointestinal symptoms and those who received an intravenous omeprazole alone, but not those who received oral lansoprazole or rabeprazole alone. It was not influenced by dosage or duration of PPIs. Conclusion: The use of intravenous PPIs alone during hospitalization may be associated with worse clinical outcome in COVID-19 patients.

Gastrointestinal Bleeding, but Not Other Gastrointestinal Symptoms, Is Associated With Worse Outcomes in COVID-19 Patients.

Background: Patients with coronavirus disease 2019 (COVID-19) can present with gastrointestinal (GI) symptoms. However, the prevalence of GI symptoms and their association with outcomes remain controversial in COVID-19 patients. Methods: All COVID-19 patients consecutively admitted to the Wuhan Huoshenshan hospital from February 2020 to April 2020 were collected. Disease severity and outcomes were compared between COVID-19 patients with and without GI symptoms. Logistic regression analyses were performed to evaluate the association of GI symptoms with the composite endpoint and death in COVID-19 patients. A composite endpoint was defined as transfer to intensive care unit, requirement of mechanical ventilation, and death. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Overall, 2,552 COVID-19 patients were included. The prevalence of GI symptoms was 21.0% (537/2,552). Diarrhea (8.9%, 226/2,552) was the most common GI symptom. Patients with GI symptoms had significantly higher proportions of severe COVID-19 and worse outcomes than those without. Univariate logistic regression analyses demonstrated that GI symptoms were significantly associated with the composite endpoint (OR = 2.426, 95% CI = 1.608-3.661; P < 0.001) and death (OR = 2.137, 95% CI = 1.209-3.778; P = 0.009). After adjusting for age, sex, and severe/critical COVID-19, GI symptoms were still independently associated with the composite endpoint (OR = 2.029, 95% CI = 1.294-3.182; P = 0.002), but not death (OR = 1.726, 95% CI = 0.946-3.150; P = 0.075). According to the type of GI symptoms, GI bleeding was an independent predictor of the composite endpoint (OR = 8.416, 95% CI = 3.465-20.438, P < 0.001) and death (OR = 6.640, 95% CI = 2.567-17.179, P < 0.001), but not other GI symptoms (i.e., diarrhea, abdominal discomfort, nausea and/or vomiting, constipation, acid reflux and/or heartburn, or abdominal pain). Conclusion: GI symptoms are common in COVID-19 patients and may be associated with their worse outcomes. Notably, such a negative impact of GI symptoms on the outcomes should be attributed to GI bleeding.

Comparison of liver biochemical abnormality between COVID-19 patients with liver cirrhosis versus COVID-19 alone and liver cirrhosis alone: A STROBE observational study.

ABSTRACT: Coronavirus disease (COVID-19) patients frequently develop liver biochemical abnormality. However, liver biochemical abnormality in COVID-19 patients with liver cirrhosis is under-recognized.Patients hospitalized during COVID-19 pandemic in China (ie, from February to April 2020) were screened. All of 17 COVID-19 patients with liver cirrhosis consecutively admitted to the Wuhan Huoshenshan Hospital were identified. Meanwhile, 17 age-, sex-, and severity-matched COVID-19 patients without liver cirrhosis admitted to this hospital were selected as a control group; all of 14 cirrhotic patients without COVID-19 consecutively admitted to the Department of Gastroenterology of the General Hospital of Northern Theater Command were selected as another control group. Incidence of liver biochemical abnormality and decompensated events were primarily compared.Among the COVID-19 patients with liver cirrhosis, the incidence of liver biochemical abnormality at admission and during hospitalization were 76.50% and 84.60%, respectively; 7 (41.20%) had decompensated events at admission; 1 was transferred to intensive care unit due to gastrointestinal bleeding. Among the COVID-19 patients without liver cirrhosis, the incidence of liver biochemical abnormality at admission and during hospitalization were 58.80% (P = .271) and 60.00% (P = .150), respectively. Among the cirrhotic patients without COVID-19, the incidence of liver biochemical abnormality at admission and during hospitalization were 69.20% (P = .657) and 81.80% (P = .855), respectively; 11 (78.60%) had decompensated events at admission (P = .036). None died during hospitalization among the three groups.Liver biochemical abnormality is common in COVID-19 patients with liver cirrhosis. Management of decompensated events in cirrhotic patients without COVID-19 should not be neglected during COVID-19 pandemic.

Risk factors for mortality of coronavirus disease 2019 (COVID-19) patients during the early outbreak of COVID-19: a systematic review and meta-analysis.

BACKGROUND: Identification of risk factors for poor prognosis of patients with coronavirus disease 2019 (COVID-19) is necessary to enable the risk stratification and modify the patient's management. Thus, we performed a systematic review and meta-analysis to evaluate the in-hospital mortality and risk factors of death in COVID-19 patients. METHODS: All studies were searched via the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases. The in-hospital mortality of COVID-19 patients was pooled. Odds ratios (ORs) or mean difference (MD) with 95% confidence intervals (CIs) were calculated for evaluation of risk factors. RESULTS: A total of 80 studies were included with a pooled in-hospital mortality of 14% (95% CI: 12.2-15.9%). Older age (MD =13.32, 95% CI: 10.87-15.77; P<0.00001), male (OR =1.66, 95% CI: 1.37-2.01; P<0.00001), hypertension (OR =2.67, 95% CI: 2.08-3.43; P<0.00001), diabetes (OR =2.14, 95% CI: 1.76-2.6; P<0.00001), chronic respiratory disease (OR =3.55, 95% CI: 2.65-4.76; P<0.00001), chronic heart disease/cardiovascular disease (OR =3.15, 95% CI: 2.43-4.09; P<0.00001), elevated levels of high-sensitive cardiac troponin I (MD =66.65, 95% CI: 16.94-116.36; P=0.009), D-dimer (MD =4.33, 95% CI: 2.97-5.68; P<0.00001), C-reactive protein (MD =48.03, 95% CI: 27.79-68.27; P<0.00001), and a decreased level of albumin at admission (MD =-3.98, 95% CI: -5.75 to -2.22; P<0.0001) are associated with higher risk of death. Patients who developed acute respiratory distress syndrome (OR =62.85, 95% CI: 29.45-134.15; P<0.00001), acute cardiac injury (OR =25.16, 95% CI: 6.56-96.44; P<0.00001), acute kidney injury (OR =22.86, 95% CI: 4.60-113.66; P=0.0001), and septic shock (OR =24.09, 95% CI: 4.26-136.35; P=0.0003) might have a higher in-hospital mortality. CONCLUSIONS: Advanced age, male, comorbidities, increased levels of acute inflammation or organ damage indicators, and complications are associated with the risk of mortality in COVID-19 patients, and should be integrated into the risk stratification system.