Non-steroidal anti-inflammatory drug use and outcomes of COVID-19 in the ISARIC Clinical Characterisation Protocol UK cohort: a matched, prospective cohort study.
Non-steroidal anti-inflammatory drug use and outcomes of COVID-19 in the ISARIC Clinical Characterisation Protocol UK cohort: a matched, prospective cohort study.
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DOI：
10.1016/s2665-9913(21)00104-1
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发表时间：
2021-07
期刊：
影响因子：
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通讯作者：
ISARIC4C Investigators
中科院分区：
文献类型：
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作者：
Drake TM;Fairfield CJ;Pius R;Knight SR;Norman L;Girvan M;Hardwick HE;Docherty AB;Thwaites RS;Openshaw PJM;Baillie JK;Harrison EM;Semple MG;ISARIC4C Investigators
在大流行早期，有人认为预先使用非甾体抗炎药（NSAIDs）可能会导致COVID-19患者疾病严重程度增加。非甾体抗炎药是一种重要的镇痛药，特别是对那些患有风湿病的人来说，并且在没有处方的情况下广泛提供给公众。来自社区研究、行政数据和住院患者的小型研究的证据表明，非甾体抗炎药与较差的COVID-19预后无关。我们的目的是表征非甾体抗炎药的安全性，并确定既往使用非甾体抗炎药是否与COVID-19疾病严重程度的增加有关。这项前瞻性多中心队列研究纳入了2020年1月17日至8月10日期间因确诊或高度疑似SARS-CoV-2感染导致COVID-19而入院的任何年龄的患者。主要结局是住院死亡率，次要结局是入院时疾病严重程度、入住重症监护、接受有创通气、接受无创通气、使用补充氧和急性肾损伤。非甾体抗炎药必须在入院前2周内使用。我们使用逻辑回归来估计非甾体抗炎药的效果，并调整混杂变量。我们使用倾向评分匹配来进一步估计非甾体抗炎药的影响，同时考虑人群中的协变量差异。在2020年1月17日至8月10日期间，我们在英格兰、苏格兰和威尔士的255家医疗机构招募了78674名患者，其中72179名患者的死亡结果可供匹配；71 915例中男性40 406例（56.2%），女性31 509例（43.8%）。在该队列中，4211例（5.8%）患者在入院前接受了全身非甾体抗炎药治疗。根据倾向评分匹配，获得非甾体抗炎药使用者和非甾体抗炎药使用者的平衡组（每组4205例患者）。在入院时，我们观察到暴露组之间的严重程度没有显著差异。在调整解释变量后，使用非甾体抗炎药与较差的住院死亡率（匹配OR为0.95,95% CI为0.84 - 0.07;p= 0.35）、重症监护住院（1.01、0.87 - 1.17;p= 0.89）、有创通气需求（0.96、0.80 - 1.17;p= 0.69）、无创通气需求（1.12、0.96 - 1.32;p= 0.14）、氧气需求（1.00、0.89 - 1.12;p= 0.97）、急性肾损伤发生（1.08、0.92 - 1.26;p= 0.33）无关。非甾体抗炎药的使用与更高的死亡率或COVID-19严重程度增加无关。决策者应考虑审查有关非甾体抗炎药处方和COVID-19严重程度的已发布建议。国家卫生研究所和医学研究委员会。
Early in the pandemic it was suggested that pre-existing use of non-steroidal anti-inflammatory drugs (NSAIDs) could lead to increased disease severity in patients with COVID-19. NSAIDs are an important analgesic, particularly in those with rheumatological disease, and are widely available to the general public without prescription. Evidence from community studies, administrative data, and small studies of hospitalised patients suggest NSAIDs are not associated with poorer COVID-19 outcomes. We aimed to characterise the safety of NSAIDs and identify whether pre-existing NSAID use was associated with increased severity of COVID-19 disease. This prospective, multicentre cohort study included patients of any age admitted to hospital with a confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 between Jan 17 and Aug 10, 2020. The primary outcome was in-hospital mortality, and secondary outcomes were disease severity at presentation, admission to critical care, receipt of invasive ventilation, receipt of non-invasive ventilation, use of supplementary oxygen, and acute kidney injury. NSAID use was required to be within the 2 weeks before hospital admission. We used logistic regression to estimate the effects of NSAIDs and adjust for confounding variables. We used propensity score matching to further estimate effects of NSAIDS while accounting for covariate differences in populations. Between Jan 17 and Aug 10, 2020, we enrolled 78 674 patients across 255 health-care facilities in England, Scotland, and Wales. 72 179 patients had death outcomes available for matching; 40 406 (56·2%) of 71 915 were men, 31 509 (43·8%) were women. In this cohort, 4211 (5·8%) patients were recorded as taking systemic NSAIDs before admission to hospital. Following propensity score matching, balanced groups of NSAIDs users and NSAIDs non-users were obtained (4205 patients in each group). At hospital admission, we observed no significant differences in severity between exposure groups. After adjusting for explanatory variables, NSAID use was not associated with worse in-hospital mortality (matched OR 0·95, 95% CI 0·84–1·07; p=0·35), critical care admission (1·01, 0·87–1·17; p=0·89), requirement for invasive ventilation (0·96, 0·80–1·17; p=0·69), requirement for non-invasive ventilation (1·12, 0·96–1·32; p=0·14), requirement for oxygen (1·00, 0·89–1·12; p=0·97), or occurrence of acute kidney injury (1·08, 0·92–1·26; p=0·33). NSAID use is not associated with higher mortality or increased severity of COVID-19. Policy makers should consider reviewing issued advice around NSAID prescribing and COVID-19 severity. National Institute for Health Research and Medical Research Council.