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Association of Nonsteroidal Anti-inflammatory Drug Use and Adverse Outcomes Among Patients Hospitalized With Influenza.
Lund, Lars Christian; Reilev, Mette; Hallas, Jesper; Kristensen, Kasper Bruun; Thomsen, Reimar Wernich; Christiansen, Christian Fynbo; Sørensen, Henrik Toft; Johansen, Nanna Borup; Brun, Nikolai Constantin; Voldstedlund, Marianne; Støvring, Henrik; Thomsen, Marianne Kragh; Christensen, Steffen; Pottegård, Anton.
  • Lund LC; Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.
  • Reilev M; Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.
  • Hallas J; Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.
  • Kristensen KB; Department of Clinical Biochemistry and Clinical Pharmacology, Odense University Hospital, Odense, Denmark.
  • Thomsen RW; Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.
  • Christiansen CF; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
  • Sørensen HT; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
  • Johansen NB; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
  • Brun NC; Center for Population Health and Sciences, Stanford University, Stanford, California.
  • Voldstedlund M; Department of Medical Evaluation and Biostatistics, Danish Medicines Agency, Copenhagen, Denmark.
  • Støvring H; Department of Medical Evaluation and Biostatistics, Danish Medicines Agency, Copenhagen, Denmark.
  • Thomsen MK; Statens Serum Institut, Copenhagen, Denmark.
  • Christensen S; Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.
  • Pottegård A; Department of Public Health-Biostatistics, Aarhus University, Aarhus, Denmark.
JAMA Netw Open ; 3(7): e2013880, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-621959
ABSTRACT
Importance During the ongoing coronavirus disease 2019 pandemic, case reports have suggested that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may lead to adverse outcomes.

Objective:

To study the association of NSAID use with adverse outcomes in patients hospitalized with influenza or influenza pneumonia. Design, Setting, and

Participants:

This cohort study used propensity score matching among 7747 individuals aged 40 years or older who were hospitalized with influenza, confirmed by polymerase chain reaction or antigen testing, between 2010 and 2018. Data were collected using Danish nationwide registers. All analyses reported were performed on May 29, 2020. Exposures Prescription fill of an NSAID within 60 days before admission. Main Outcomes and

Measures:

Risk ratio (RR) and risk difference (RD) with 95% CIs for intensive care unit admission and death within 30 days of admission.

Results:

A total of 7747 patients (median [interquartile range] age, 71 [59-80] years, 3980 [51.4%] men) with confirmed influenza were identified. Of these, 520 (6.7%) were exposed to NSAIDs. In the unmatched cohorts, 104 of 520 patients (20.0%) who used NSAIDs and 958 of 7227 patients (13.3%) who did not use NSAIDs were admitted to the intensive care unit. For death within 30 days of admission, we observed 37 events (7.1%) among those who used NSAIDs compared with 563 events (7.8%) among those who did not. Current NSAID use was associated with intensive care unit admission (RR, 1.51; 95% CI, 1.26 to 1.81; RD, 6.7%; 95% CI, 3.2% to 10.3%), while NSAID use was not associated with death (RR, 0.91; 95% CI, 0.66 to 1.26; RD, -0.7%; 95% CI, -3.0% to 1.6%). In the matched cohorts, risks were unchanged for patients who used NSAIDs, while 83 ICU admissions (16.0%) and 36 deaths (6.9%) were observed among matched individuals who did not use NSAIDs. Matched (ie, adjusted) analyses yielded attenuated risk estimates for intensive care unit admission (RR, 1.25; 95% CI, 0.95 to 1.63; RD, 4.0%; 95% CI, -0.6% to 8.7%) and death (RR, 1.03; 95% CI, 0.66 to 1.60; RD, 0.2%; 95% CI, -2.9% to 3.3%). Associations were more pronounced among patients who used NSAIDs for a longer period (eg, for intensive care unit admission RR, 1.90; 95% CI, 1.19 to 3.06; RD, 13.4%; 95% CI, 4.0% to 22.8%). Conclusions and Relevance In this cohort study of adult patients hospitalized with influenza, the use of NSAIDs was not associated with 30-day intensive care unit admission or death in adjusted analyses. There was an association between long-term use of NSAIDs and intensive care unit admission.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Anti-Inflammatory Agents, Non-Steroidal / Coronavirus Infections / Hospitalization / Intensive Care Units Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: JAMA Netw Open Year: 2020 Document Type: Article Affiliation country: Jamanetworkopen.2020.13880

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Anti-Inflammatory Agents, Non-Steroidal / Coronavirus Infections / Hospitalization / Intensive Care Units Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: JAMA Netw Open Year: 2020 Document Type: Article Affiliation country: Jamanetworkopen.2020.13880