Pharmacotherapy and pulmonary fibrosis risk after SARS-CoV-2 infection: a prospective nationwide cohort study in the United States.
Pharmacotherapy and pulmonary fibrosis risk after SARS-CoV-2 infection: a prospective nationwide cohort study in the United States.
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DOI：
10.1016/j.lana.2023.100566
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发表时间：
2023-09
期刊：
影响因子：
--
通讯作者：
Solway, Julian
中科院分区：
文献类型：
--
作者：
Adegunsoye, Ayodeji;Baccile, Rachel;Best, Thomas J.;Zaksas, Victoria;Zhang, Hui;Karnik, Rasika;Patel, Bhakti K.;Solomonides, Anthony E.;Parker, William F.;Solway, Julian
肺纤维化以肺实质破坏为特征，可增加发病率和死亡率。肺纤维化通常发生在因SARS-CoV-2感染住院治疗后。由于存在改变肺纤维化风险的药物，我们研究了不同的药物治疗（胺碘酮、癌症化疗、皮质类固醇和利妥昔单抗）是否与COVID-19后肺纤维化发病率的差异相关。我们使用了国家COVID-19队列协作（N3 C）数据飞地，该数据飞地汇总并协调了美国各地的COVID-19数据，以评估2020年1月1日至2022年7月6日期间住院的成人中在COVID-19诊断后至少60天记录的肺纤维化发病率，这些成人没有预先存在的肺纤维化。我们使用倾向评分，根据已知对肺纤维化发生率有影响的协变量，将COVID-19前药物暴露和未暴露队列（1：1）进行匹配，并估计药物暴露与COVID-19后肺纤维化风险的相关性。敏感性分析考虑了住院后至少30天或90天记录的肺纤维化发生率和COVID-19阴性N3 C人群的肺纤维化发生率。在5，923，394名COVID-19患者中，我们分析了452，951名住院成人，其中肺纤维化发病率为1.1/100人年。我们的主要分析包括277，984名患有COVID-19的住院成年人，其中所有药物暴露队列与未暴露队列匹配良好（标准化平均差异<0.1）。利妥昔单抗组的COVID-19后肺纤维化发病率比（IRR）为2.5（95% CI 1.2-5.1，P = 0.01），化疗组为1.6（95% CI 1.3-2.0，P < 0.0001），皮质类固醇组为1.2（95% CI 1.0-1.3，P = 0.02）。胺碘酮暴露与COVID-19后肺纤维化无显著相关性（IRR = 0.8，95% CI 0.6-1.1，P = 0.24）。在敏感性分析中，COVID-19前皮质类固醇的使用与COVID-19后肺纤维化并不一致。在COVID-19阴性住院人群（n = 1，240，461）中，肺纤维化的发病率总体较低（0.6/100人-年），暴露于所有四种药物的患者的发病率也较低。住院患者在COVID-19感染前近期接受利妥昔单抗或癌症化疗与COVID-19后肺纤维化风险增加相关。本出版物中描述的分析是使用通过NCATS N3 C Data Enclave https://covid.cd2h.org和N3 C Attribution & Publication Policy v1.2-2020-08- 25 b访问的数据或工具进行的，该政策由K23 HL 146942，K 08 HL 150291，K23 HL 148387，UL 1 TR 002389，U24 TR 002306和来自/的SECURED授权支持。粮食计划署从联合国获得一笔赠款。这项研究是可能的，因为患者的信息包括在数据和组织（https：//ncats.nih.gov/n3c/resources/data-contribution/data-transfer-agreement-signatures）和科学家谁有助于这个社区资源的持续发展（https：//doi.org/10.1093/jamia/ocaa196）。
Pulmonary fibrosis is characterized by lung parenchymal destruction and can increase morbidity and mortality. Pulmonary fibrosis commonly occurs following hospitalization for SARS-CoV-2 infection. As there are medications that modify pulmonary fibrosis risk, we investigated whether distinct pharmacotherapies (amiodarone, cancer chemotherapy, corticosteroids, and rituximab) are associated with differences in post-COVID-19 pulmonary fibrosis incidence. We used the National COVID-19 Cohort Collaboration (N3C) Data Enclave, which aggregates and harmonizes COVID-19 data across the United States, to assess pulmonary fibrosis incidence documented at least 60 days after COVID-19 diagnosis among adults hospitalized between January 1st, 2020 and July 6th, 2022 without pre-existing pulmonary fibrosis. We used propensity scores to match pre-COVID-19 drug-exposed and unexposed cohorts (1:1) based on covariates with known influence on pulmonary fibrosis incidence, and estimated the association of drug exposure with risk for post-COVID-19 pulmonary fibrosis. Sensitivity analyses considered pulmonary fibrosis incidence documented at least 30- or 90-days post-hospitalization and pulmonary fibrosis incidence in the COVID-19-negative N3C population. Among 5,923,394 patients with COVID-19, we analyzed 452,951 hospitalized adults, among whom pulmonary fibrosis incidence was 1.1 per 100-person-years. 277,984 hospitalized adults with COVID-19 were included in our primary analysis, among whom all drug exposed cohorts were well-matched to unexposed cohorts (standardized mean differences <0.1). The post-COVID-19 pulmonary fibrosis incidence rate ratio (IRR) was 2.5 (95% CI 1.2–5.1, P = 0.01) for rituximab, 1.6 (95% CI 1.3–2.0, P < 0.0001) for chemotherapy, and 1.2 (95% CI 1.0–1.3, P = 0.02) for corticosteroids. Amiodarone exposure had no significant association with post-COVID-19 pulmonary fibrosis (IRR = 0.8, 95% CI 0.6–1.1, P = 0.24). In sensitivity analyses, pre-COVID-19 corticosteroid use was not consistently associated with post-COVID-19 pulmonary fibrosis. In the COVID-19 negative hospitalized population (n = 1,240,461), pulmonary fibrosis incidence was lower overall (0.6 per 100-person-years) and for patients exposed to all four drugs. Recent rituximab or cancer chemotherapy before COVID-19 infection in hospitalized patients is associated with increased risk for post-COVID-19 pulmonary fibrosis. The analyses described in this publication were conducted with data or tools accessed through the NCATS N3C Data Enclave https://covid.cd2h.org and N3C Attribution & Publication Policy v1.2-2020-08-25b supported by K23HL146942, K08HL150291, K23HL148387, UL1TR002389, U24 TR002306, and a SECURED grant from the /, . WFP received a grant from the . This research was possible because of the patients whose information is included within the data and the organizations (https://ncats.nih.gov/n3c/resources/data-contribution/data-transfer-agreement-signatories) and scientists who have contributed to the on-going development of this community resource (https://doi.org/10.1093/jamia/ocaa196).
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DOI：
10.1186/s43055-021-00484-3
发表时间：
2021-04-13
期刊：
The Egyptian Journal of Radiology and Nuclear Medicine
影响因子：
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10.1093/jamia/ocaa196
发表时间：
2021-03-01
影响因子：
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