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Risk factors of COVID-19 mortality: a systematic review of current literature and lessons from recent retracted articles.
Lee, K H; Kim, J S; Hong, S H; Seong, D; Choi, Y R; Ahn, Y T; Kim, K S; Kim, S E; Lee, S; Sim, W; Kim, D; Jun, B; Yang, J W; Yon, D K; Lee, S W; Kim, M S; Dragioti, E; Li, H; Jacob, L; Koyanagi, A; Abou Ghayda, R; Shin, J I; Smith, L.
  • Lee KH; Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea. shinji@yuhs.ac.
Eur Rev Med Pharmacol Sci ; 24(24): 13089-13097, 2020 12.
Article in English | MEDLINE | ID: covidwho-1000855
ABSTRACT

OBJECTIVE:

Recently, two influential articles that reported the association of (hydroxy)chloroquine or angiotensin converting enzyme (ACE) inhibitors and coronavirus disease 2019 (COVID-19) mortality were retracted due to significant methodological issues. Therefore, we aimed to analyze the same clinical issues through an improved research method and to find out the differences from the retracted papers. We systematically reviewed pre-existing literature, and compared the results with those of the retracted papers to gain a novel insight. MATERIALS AND

METHODS:

We extracted common risk factors identified in two retracted papers, and conducted relevant publication search until June 26, 2020 in PubMed. Then, we analyzed the risk factors for COVID-19 mortality and compared them to those of the retracted papers.

RESULTS:

Our systematic review demonstrated that most demographic and clinical risk factors for COVID-19 mortality were similar to those of the retracted papers. However, while the retracted paper indicated that both (hydroxy)chloroquine monotherapy and combination therapy with macrolide were associated with higher risk of mortality, our study showed that only combination therapy of hydroxychloroquine and macrolide was associated with higher risk of mortality (odds ratio 2.33; 95% confidence interval 1.63-3.34). In addition, our study demonstrated that use of ACE inhibitors or angiotensin receptor blockers (ARBs) was associated with reduced risk of mortality (0.77; 0.65-0.91).

CONCLUSIONS:

When analyzing the same clinical issues with the two retracted papers through a systematic review of randomized controlled trials and relevant cohort studies, we found out that (hydroxy)chloroquine monotherapy was not associated with higher risk of mortality, and that the use of ACE inhibitors or ARBs was associated with reduced risk of mortality in COVID-19 patients.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Retraction of Publication as Topic / Angiotensin-Converting Enzyme Inhibitors / Enzyme Inhibitors / Angiotensin Receptor Antagonists / COVID-19 / Hydroxychloroquine Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Eur Rev Med Pharmacol Sci Journal subject: Pharmacology / Toxicology Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Retraction of Publication as Topic / Angiotensin-Converting Enzyme Inhibitors / Enzyme Inhibitors / Angiotensin Receptor Antagonists / COVID-19 / Hydroxychloroquine Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Eur Rev Med Pharmacol Sci Journal subject: Pharmacology / Toxicology Year: 2020 Document Type: Article