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COVID-19 outcomes among hospitalized men with or without exposure to alpha-1-adrenergic receptor blocking agents (preprint)
medrxiv; 2021.
Preprint
in English
| medRxiv | ID: ppzbmed-10.1101.2021.04.08.21255148
ABSTRACT
Importance Alpha-1-adrenergic receptor antagonists (1-blockers) can abrogate pro-inflammatory cytokines and may improve outcomes among patients with respiratory infections. Repurposing readily available drugs such as 1-blockers could augment the medical response to the COVID-19 pandemic. Objective:
To evaluate the association between 1-blocker exposure and COVID-19 mortalityDesign:
Real-world evidence studySetting:
Patient level data with 32,355 records tested for SARS-CoV-2 at the Mount Sinai Health System including 8,442 laboratory-confirmed cases extracted from five member hospitals in the New York City metropolitan area.Participants:
2,627 men aged 45 or older admitted with COVID-19 between February 24 and May 31, 2020 Exposures 1-blocker use as an outpatient or while admitted for COVID-19 Main Outcomes andMeasures:
In-hospital mortalityResults:
Men exposed to 1-blockers (N=436) were older (median age 73 vs. 64 years, P<0.001) and more likely to have comorbidities than unexposed men (N=2,191). Overall, 758 (28.9%) patients died in hospital, 1,589 (60.5%) were discharged, and 280 (10.7%) were still hospitalized as of May 31, 2020. Outpatient exposure to 1-blockers was not associated with COVID-19 hospital outcomes, though there was a trend towards significance (OR 0.749, 95% CI 0.527-1.064; P=0.106). Conversely, inpatient use of 1-blockers was independently associated with improved in-hospital mortality in both multivariable logistic (OR 0.633, 95% CI 0.434-0.921; P=0.017) and Cox regression analyses (HR 0.721, 95% CI 0.572-0.908; P=0.006) adjusting for patient demographics, comorbidities, and baseline vitals and labs. Age-stratified analyses suggested greater benefit from inpatient 1-blocker use among younger age groups Age 45-65 OR 0.384, 95% CI 0.164-0.896 (P=0.027); Age 55-75 OR 0.511, 95% CI 0.297-0.880 (P=0.015); Age 65-89 OR 0.810, 95% CI 0.509-1.289 (P=0.374). Conclusions and Relevance Inpatient 1-blocker use was independently associated with improved COVID-19 mortality among hospitalized men. Clinical trials to assess the therapeutic value of 1-blockers in COVID-19 are warranted.
Full text:
Available
Collection:
Preprints
Database:
medRxiv
Main subject:
Respiratory Tract Infections
/
COVID-19
Language:
English
Year:
2021
Document Type:
Preprint
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