A retrospective analysis of clinical outcomes between hospitalized patients with COVID-19 who received famotidine or pantoprazole.

Background and Aim: There is limited research on the use of histamine-H2 receptor antagonists and proton pump inhibitors for treating COVID-19. We compare clinical outcomes between patients hospitalized with COVID-19 receiving famotidine or pantoprazole. Methods: This retrospective study included 2184 patients (famotidine: n = 638, pantoprazole: n = 727, nonuse: n = 819) aged 18 years or older treated for COVID-19 from March 2020 to March 2021. Patients who received both famotidine and pantoprazole treatments were excluded. Multivariate logistic regression was used for the primary outcome, namely all-cause mortality, and the secondary outcomes, namely mechanical ventilation, vasopressor use, acute kidney injury, and gastrointestinal bleeding. The main predictor variable was the use of famotidine or pantoprazole. Covariates were demographics, chronic diseases, and symptoms. Results: As compared to nonuse, famotidine (OR: 0.30, 95% CI: 0.20-0.44, P < 0.001) and pantoprazole (OR: 0.47, 95% CI: 0.33-0.66, P < 0.001) were significantly associated with lower odds for all-cause mortality. Comparison of famotidine and pantoprazole showed that the former had lower odds for all-cause mortality (OR: 0.65, 95% CI:0.45-0.95, P < 0.05), mechanical ventilation (OR: 0.38, 95% CI: 0.25-0.58, P < 0.001), vasopressor use (OR: 0.33, 95% CI: 0.22-0.48, P < 0.001), acute kidney injury (OR: 0.40, 95% CI: 0.30-0.54, P < 0.001), and gastrointestinal bleeding (OR: 0.15, 95% CI: 0.08, 0.29, P < 0.001). Conclusions: Famotidine is associated with lower odds for all-cause mortality, mechanical ventilation, vasopressor use, acute kidney injury, and gastrointestinal bleeding as compared to pantoprazole in patients hospitalized with COVID-19. We recommend that clinicians consider the use of famotidine over pantoprazole for hospitalized COVID-19 patients. Future research with a clinical trial would be beneficial to further support such use of famotidine.

Hypertension and Gastrointestinal Bleed in COVID-19 Patients: Associations with Mortality, Acute Kidney Injury, Vasopressor Use, and Mechanical Ventilation Use.

There are mixed findings on the association of hypertension or gastrointestinal bleed (GIB) with mortality in COVID-19 patients but no research on the combination of both hypertension and GIB with mortality in COVID-19 patients. We study in COVID-19 patients the association of hypertension and GIB with mortality, acute kidney injury (AKI), vasopressor use, and/or mechanical ventilation. This is a retrospective study of COVID-19 patients who were categorized into groups of no GIB/no hypertension (n = 653), yes hypertension/no GIB (n = 1,620), yes GIB/no hypertension (n = 104), or yes GIB/yes hypertension (n = 334). Covariates included demographics and medical history variables. In the multi-variate logistic regression analysis for the composite outcome of mortality, AKI, vasopressor use, and/or mechanical ventilation use, yes hypertension/no GIB (OR: 1.47, 95% CI: 1.13, 1.89, p <0.001) and yes GIB/no hypertension (OR: 1.68, 95% CI: 1.02, 2.78, p <0.001) were each significantly positively associated with the composite outcome. The yes GIB/yes hypertension group was not significantly associated with the composite outcome. In conclusion, we found that hypertension or GIB alone were each significantly associated with increased odds for the composite outcome while having both hypertension and GIB was protective and not significantly associated with the composite outcome. We recommend that clinicians be aware of such findings when treating patients with COVID-19, as those with both hypertension and GIB may not need as aggressive treatment as compared to those with either hypertension or GIB.

Hepatic Cyst: An Unusual Suspect of Syncope.

The patient is a 75-year-old man with history of diabetes and hypertension who presented with syncope after experiencing sharp, 10/10 right flank and abdominal pain worsening over three weeks associated with decreased appetite. Physical examination revealed hepatomegaly and right lower quadrant (RUQ) tenderness, negative for peritoneal signs. Bloodwork showed leukocytosis (13 K/mcl), alkaline phosphatase (141 U/L), total bilirubin (2.0 mg/dL), and gamma-glutamyl transferase (172 U/L). Computed Tomography (CT) revealed multiple hepatic cysts with the largest measuring 17 × 14 × 18 cm (Figure 1). Parenteral opiates provided minimal relief. Cardiac and neurologic etiologies of syncope were ruled out. The patient's course was complicated by opioid-induced delirium as his abdominal pain progressively worsened despite escalating doses of parenteral and oral analgesics. Gastroenterology and interventional radiology consulted to evaluate for Glisson's capsular stretch. Therapeutic aspiration yielded 2.5 L of serous fluid, which alleviated the patient's pain. Cytology was negative for malignancy. Opiates were titrated down. Repeat CT (Figure 2) showed cysts that were significantly reduced in size. The patient showed complete resolution of symptoms and was subsequently discharged. We present a rare case of a large hepatic cyst causing syncope. In the appropriate clinical setting, syncope with RUQ tenderness and hepatomegaly should raise the index of suspicion for hepatic cysts.