Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis

BACKGROUND

Laboratory testing is commonly performed in patients with COVID-19. Each of the laboratory parameters has potential value for risk stratification and prediction of COVID-19 outcomes. This systematic review and meta-analysis aimed to evaluate the difference between these parameters in severe and nonsevere disease and to provide the optimal cutoff value for predicting severe disease.

METHOD

We performed a systematic literature search through electronic databases. The variables of interest were serum procalcitonin, albumin, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) levels in each group of severity outcomes from COVID-19.

RESULTS

There were a total of 4848 patients from 23 studies. Our meta-analysis suggest that patients with severe COVID-19 infections have higher procalcitonin, (mean difference 0.07; 95% CI 0.05-0.10; p < 0.00001), CRP (mean difference 36.88; 95% CI 29.10-44.65; p < 0.00001), D-Dimer (mean difference 0.43; 95% CI 0.31-0.56; p < 0.00001), and LDH (mean difference 102.79; 95% CI 79.10-126.49; p < 0.00001) but lower levels of albumin (mean difference -4.58; 95% CI -5.76 to -3.39; p < 0.00001) than those with nonsevere COVID-19 infections. The cutoff values for the parameters were 0.065 ng/mL for procalcitonin, 38.85 g/L for albumin, 33.55 mg/L for CRP, 0.635 μ/L for D-dimer, and 263.5 U/L for LDH, each with high sensitivity and specificity.

CONCLUSION

This meta-analysis suggests elevated procalcitonin, CRP, D-dimer, and LDH and decreased albumin can be used for predicting severe outcomes in COVID-19.

Dementia and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: A systematic review and meta-analysis

BACKGROUND

The number of positive and death cases from coronavirus disease 2019 (COVID-19) is still increasing until now. One of the most prone individuals, even in normal situations is patients with dementia. Currently, no study provides clear evidence regarding the link between dementia and COVID-19. This study aims to analyze the relationship between dementia and poor outcomes of COVID-19 infection.

MATERIALS AND METHODS

We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until October 25th, 2020. All articles published on COVID-19 and dementia were retrieved. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies. Statistical analysis was done using Review Manager 5.4 software.

RESULTS

A total of 24 studies with 46,391 dementia patients were included in this meta-analysis. This meta-analysis showed that dementia was associated with composite poor outcome [RR 2.67 (95% CI 2.06 - 3.47), p < 0.00001, I2 = 99%, random-effect modeling] and its subgroup which comprised of risk of COVID-19 infection [RR 2.76 (95% CI 1.43 - 5.33), p = 0.003, I2 = 99%, random-effect modeling], severe COVID-19 [RR 2.63 (95% CI 1.41 - 4.90), p = 0.002, I2 = 89%, random-effect modeling], and mortality from COVID-19 infection [RR 2.62 (95% CI 2.04 - 3.36), p < 0.00001, I2 = 96%, random-effect modeling].

CONCLUSIONS

Extra care and close monitoring should then be provided to patients with dementia to minimize the risk of infections, preventing the development of severe and mortality outcomes.

Dyslipidemia is associated with severe coronavirus disease 2019 (COVID-19) infection

BACKGROUND AND AIMS

The number of positive and death cases from coronavirus disease 2019 (COVID-19) is still increasing. The identification of risk factors for severe outcomes is important. Dyslipidemia has been shown as a long-known risk factor for cardiovascular disease. The aim of this study is to analyze the potential association between dyslipidemia and the severity of COVID-19 infection.

METHODS

We systematically searched the PubMed database using specific keywords related to our aims until July 9th, 2020. All articles published on COVID-19 and dyslipidemia were retrieved. Statistical analysis was done using Review Manager 5.4 software.

RESULTS

A total of 7 studies with a total of 6922 patients were included in our analysis. Our meta-analysis showed that dyslipidemia is associated with severe COVID-19 infections [RR 1.39 (95% CI 1.03-1.87), p = 0.03, I2 = 57%, random-effect modelling].

CONCLUSION

Dyslipidemia increases the risk of the development of severe outcomes from COVID-19 infections. Patients with dyslipidemia should be monitored closely to minimize the risk of COVID-19.

Statin therapy did not improve the in-hospital outcome of coronavirus disease 2019 (COVID-19) infection

BACKGROUND AND AIMS

The coronavirus disease 2019 (COVID-19) number of death cases is still increasing. One of the comorbidities associated with severe outcome and mortality of COVID-19 is dyslipidemia. Statin is one of the drugs which is most commonly used for the treatment of dyslipidemic patients. This study aims to analyze the association between statin use and in-hospital outcomes of COVID-19 infection.

METHODS

We systematically searched the Google Scholar database using specific keywords related to our aims until August 1st, 2020. All articles published on COVID-19 and statin were retrieved. Statistical analysis was done using Review Manager 5.4 software.

RESULTS

A total of 9 studies with a total of 3449 patients were included in our analysis. Our meta-analysis showed that statin use did not improve severity outcome [OR 1.64 (95% CI 0.51-5.23), p = 0.41, I2 = 93%, random-effect modelling] nor mortality rate from COVID-19 infection [OR 0.78 (95% CI 0.50-1.21), p = 0.26, I2 = 0%, fixed-effect modelling].

CONCLUSION

Statin use did not improve in-hospital outcomes of COVID-19 infections. Patients with dyslipidemia should continue taking statin drugs despite COVID-19 infection status, given its beneficial effects on cardiovascular outcomes.

Metformin use is associated with reduced mortality rate from coronavirus disease 2019 (COVID-19) infection

BACKGROUND AND AIMS

The coronavirus disease 2019 (COVID-19) pandemic has caused a significant impact on all aspects of life. One of the comorbidities associated with severe outcome and mortality of COVID-19 is diabetes. Metformin is one of the drugs which is most commonly used for the treatment of diabetes patients. This study aims to analyze the potential benefit of metformin use in reducing the mortality rate from COVID-19 infection.

METHODS

We systematically searched the Google Scholar database using specific keywords related to our aims until August 3rd, 2020. All articles published on COVID-19 and metformin were retrieved. Statistical analysis was done using Review Manager 5.4 software.

RESULTS

A total of 5 studies with a total of 6937 patients were included in our analysis. Our meta-analysis showed that metformin use is associated with reduction in mortality rate from COVID-19 infections [RR 0.54 (95% CI 0.32-0.90), p = 0.02, I 2 = 54%, random-effect modelling].

CONCLUSION

Metformin has shown benefits in reducing the mortality rate from COVID-19 infections. Patients with diabetes should be advised to continue taking metformin drugs despite COVID-19 infection status.

Obstructive sleep apnea (OSA) and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: a systematic review and meta-analysis

BACKGROUND

Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder which could impair someone's quality of life and is also associated with poor outcomes from many diseases. Currently, the evidence regarding the link between OSA and coronavirus disease 2019 (COVID-19) is still conflicting. This study aims to analyze the relationship between OSA and poor outcomes of COVID-19.

MATERIALS AND METHODS

We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 10th, 2020. All articles published on COVID-19 and OSA were retrieved. The quality of the study was assessed using the Newcastle-Ottawa Scale (NOS) tool for observational studies. Statistical analysis was done using Review Manager 5.4 software.

RESULTS

A total of 21 studies with 54,276 COVID-19 patients were included in this meta-analysis. This meta-analysis showed that OSA was associated with composite poor outcome [OR 1.72 (95% CI 1.55-1.91), p < 0.00001, I2 = 36%, random-effect modeling] and its subgroup which comprised of severe COVID-19 [OR 1.70 (95% CI 1.18-2.45), p = 0.005], ICU admissions [OR 1.76 (95% CI 1.51-2.05), p < 0.00001], the need for mechanical ventilation [OR 1.67 (95% CI 1.48-1.88), p < 0.00001], and mortality [OR 1.74 (95% CI 1.39-2.19), p < 0.00001].

CONCLUSIONS

Extra care and close monitoring should be provided to patients with OSA to minimize the risk of infections. Simple questionnaires such as STOP-Bang questionnaire can be used for screening patients who may be at risk for severe adverse outcomes.

Colchicine treatment can improve outcomes of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

Currently, there is no widely acceptable and proven effective treatment for coronavirus disease 2019 (COVID-19). Colchicine has been shown to offer a benefit in reducing the inflammation in several inflammatory diseases. This study aims to analyze the efficacy of colchicine administration and outcomes of COVID-19. We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until January 29, 2021. All articles published on COVID-19 and colchicine treatment were retrieved. The quality of the study was assessed using the Newcastle-Ottawa Scale (NOS) tool for observational studies and Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for clinical trial studies. Statistical analysis was done using Review Manager 5.4 software. A total of eight studies with 5778 COVID-19 patients were included in this meta-analysis. This meta-analysis showed that the administration of colchicine was associated with improvement of outcomes of COVID-19 [OR 0.43 (95% CI 0.34-0.55), p < 0.00001, I2  = 0%, fixed-effect modelling] and its subgroup which comprised of reduction from severe COVID-19 [OR 0.44 (95% CI 0.31-0.63), p < 0.00001, I2  = 0%, fixed-effect modelling] and reduction of mortality rate from COVID-19 [OR 0.43 (95% CI 0.32-0.58), p < 0.00001, I2  = 0%, fixed-effect modelling]. Our study suggests the routine use of colchicine for treatment modalities of COVID-19 patients. More randomized clinical trial studies are still needed to confirm the results from this study.

Pre-admission glucagon-like peptide-1 receptor agonist (GLP-1RA) and mortality from coronavirus disease 2019 (Covid-19): A systematic review, meta-analysis, and meta-regression

AIMS

GLP-1RA has many beneficial properties, including anti-inflammatory, anti-obesogenic, pulmonary protective effects as well as beneficial impact on gut microbiome. However, the evidence regarding the benefit of GLP-1RA in Covid-19 patients with diabetes is still unclear. This study sought to analyze the benefit of pre-admission use of GLP-1RA in altering the mortality outcomes of coronavirus disease 2019 (Covid-19) patients with diabetes mellitus.

METHODS

Using specific keywords, we comprehensively searched the potential articles on PubMed, Europe PMC, and medRxiv database until June 12th, 2021. All published studies on Covid-19 and GLP-1RA were retrieved. Statistical analysis was conducted using Review Manager 5.4 and Comprehensive Meta-Analysis version 3 software.

RESULTS

A total of 9 studies with 19,660 diabetes mellitus patients who were infected by SARS-CoV-2 were included in the meta-analysis. Our data suggested that pre-admission use of GLP-1RA was associated with reduction in mortality rate from Covid-19 in patients with diabetes mellitus (OR 0.53; 95 %CI: 0.43-0.66, p < 0.00001, I2 = 0%, random-effect modelling). Further analysis showed that the associations were not influenced by age (p = 0.213), gender (p = 0.421), hypertension (p = 0.131), cardiovascular disease (p = 0.293), nor the use of metformin (p = 0.189) and insulin (p = 0.117).

CONCLUSIONS

Our study suggests that pre-admission use of GLP-1RA may offer beneficial effects on Covid-19 mortality in patients with diabetes mellitus. However, more randomized clinical trials are required to confirm this conclusion.

Tocilizumab administration is associated with the reduction in biomarkers of coronavirus disease 2019 infection

Coronavirus disease 2019 (COVID-19) has caused a significant impact on all aspects of life, with the number of death cases still increasing. Therefore, identification of potential treatment for reducing the severity of the disease is important. Currently, the data regarding the effectiveness of tocilizumab as treatment agents for COVID-19 infection is still conflicting. This study aims to give clear evidence regarding the potential benefit of tocilizumab in reducing the biomarkers of COVID-19 infection. We systematically searched the PubMed Central database using specific keywords related to our aims until July 24th, 2020. All articles published on COVID-19 and tocilizumab were retrieved. A total of 9 studies with a total of 577 patients were included in our analysis. Our meta-analysis showed that tocilizumab treatment is associated with reduction of C-reactive protein (mean difference [MD]: -106.69 mg/L [95% confidence interval [CI]: -146.90, -66.49 mg/L], p < .00001; I2  = 98%, random-effect modeling), d-dimer (MD: -3.06 mg/L [95% CI: -5.81, -0.31 mg/L], p = .03; I2  = 98%, random-effect modeling), Ferritin (MD: -532.80 ng/ml [95% CI: -810.93, -254.67 ng/ml], p = .0002; I2  = 25%, random-effect modeling), procalcitonin (MD: -0.67 ng/ml [95% CI: -1.13, -0.22 ng/ml], p = .004; I2  = 92%, random-effect modeling], and increment in the levels of lymphocyte count (MD: 0.36 × 103 /μl [95% CI: 0.18, 0.54 × 103 /μl], p < .0001; I2  = 88%, random-effect modeling). Administration of tocilizumab is effective in reducing the biomarkers of the COVID-19 infection.

Appetite problem in cancer patients: Pathophysiology, diagnosis, and treatment

AIM

This study aims to review the current evidence regarding appetite problem in cancer patients, mainly focusing on pathophysiology, diagnosis, and treatment.

INTRODUCTION

Anorexia is the common symptom of malnutrition in cancer patients. Recently, the understanding of the pathophysiological mechanism of the appetite problem in cancer patients has been increasing that give impact to rigorous research to find the therapies for improving appetite in cancer patients.

DISCUSSION

The development of anorexia in cancer patients is a complex process that involves many cytokines, receptors, chemical mediators/substances, hormones, and peptides. Growth and differentiation factor-15 (GDF-15) and toll-like receptor (TLR-4) have recently been found to be implicated in the pathogenesis of anorexia. To help diagnose the appetite problem in cancer patients, several questionnaires can be used, starting from well-known questionnaires such as Functional Assessment of Anorexia Cachexia Therapy (FAACT), Visual Analog Scale (VAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ30). Several drugs with different mechanisms of action have been studied to help in improving appetite in cancer patients. New repurposed agents such as anamorelin, mirtazapine, thalidomide, and eicosapentaenoic acid (EPA) have shown a beneficial effect in improving appetite and quality of life in cancer patients, however more phase 3 clinical trial studies is still needed.

CONCLUSION

The pathophysiology of appetite problems in cancer patients is a complex process that involves many factors. Several drugs that target those factors have been studied, however more phase 3 clinical trial studies are needed to confirm the findings from previous studies.

Efficacy and Safety of Tocilizumab for Coronavirus Disease 2019 (Covid-19) Patients: A Systematic Review and Meta-analysis

BACKGROUND

Currently, the data regarding the effectiveness and safety of tocilizumab as treatment for COVID-19 infection is still conflicting. This study aims to give clear evidence regarding the potential benefit and safety of tocilizumab in improving the outcome of COVID-19 patients.

METHODS

We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until November 1st, 2020. All articles published on COVID-19 and tocilizumab were retrieved. Statistical analysis was done using Review Manager 5.4 software.

RESULTS

A total of 38 studies with a total of 13 412 COVID-19 patients were included in our analysis. Our meta-analysis showed that tocilizumab treatment is associated with reduction of mortality rate from COVID-19 [OR 0.54 (95% CI 0.42-0.71), p<0.00001, I 2=79%, random-effect modelling], but did not alter the severity of COVID-19 [OR 1.05 (95% CI 0.92-1.20), p=0.47, I 2=84%, random-effect modelling] and length of hospital stay [Mean Difference 1.77 days (95% CI -0.61-4.14 days), p=0.15, I 2=97%, random-effect modelling]. Tocilizumab also does not associated with serious adverse events compared with standard of care treatment [OR 0.91 (95% CI 0.71-1.15), p=0.42, I 2=46%, random-effect modelling].

CONCLUSION

Our study does not support the routine use of tocilizumab for COVID-19 patients. Future studies should focus more on other potential therapies for COVID-19 patients.

Delirium is a good predictor for poor outcomes from coronavirus disease 2019 (COVID-19) pneumonia: A systematic review, meta-analysis, and meta-regression

AIM

Delirium is a common presenting symptom among older patients. Patients who presented with delirium may have a higher morbidity and mortality rate due to older age, other comorbidities, and atypical COVID-19 presentation. Currently, the evidence supporting delirium as one of the predictors of poor outcome of COVID-19 is still insufficient. This study aims to explore the potential association between delirium and poor outcomes from COVID-19.

METHODS

We systematically searched the PubMed and Google Scholar databases using specific keywords related to our aims until January 30th, 2021. All articles published on COVID-19 and delirium were retrieved. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies and Joanna Briggs Institute (JBI) Critical Appraisal Tools for case-series studies. Statistical analysis was done using Review Manager 5.4 software.

RESULTS

Our meta-analysis of 20 studies showed that delirium symptoms on admission was associated with poor outcomes from COVID-19 [OR 2.36 (95% CI 1.80-3.09), p < 0.00001, I2 = 76%, random-effect models] and its subgroup which consist of severe COVID-19 [OR 3.89 (95% CI 1.72-8.75), p = 0.001, I2 = 91%, random-effect models], and mortality from COVID-19 [OR 1.90 (95% CI 1.55-2.33), p < 0.00001, I2 = 36%, random-effect models]. Meta-regression showed that the association was influenced by age (p = 0.005).

CONCLUSIONS

Our study suggests delirium as an important marker to identify patients at higher risk for developing poor COVID-19 outcomes. The physicians should add delirium as one of the common presenting symptoms of COVID-19 in older populations.

Anosmia/Hyposmia is a Good Predictor of Coronavirus Disease 2019 (COVID-19) Infection: A Meta-Analysis

Introduction  The number of positive cases and deaths from the coronavirus disease 2019 (COVID-19) is still increasing. The early detection of the disease is very important. Olfactory dysfunction has been reported as the main symptom in part of the patients. Objective  To analyze the potential usefulness of anosmia or hyposmia in the detection of the COVID-19 infection. Data Synthesis  We systematically searched the PubMed Central database using specific keywords related to our aims until July 31st, 2020. All articles published on COVID-19 and anosmia or hyposmia were retrieved. A statistical analysis was performed using the Review Manager (RevMan, Cochrane, London, UK) software, version 5.4. A total of 10 studies involving 21,638 patients were included in the present analysis. The meta-analysis showed that anosmia or hyposmia is significantly associated with positive COVID-19 infections (risk ratio [RR]: 4.56; 95% confidence interval [95%CI]: 3.32-6.24; p  < 0.00001; I 2  = 78%, random-effects modeling). Conclusion  The presence of anosmia or hyposmia is a good predictor of positive COVID-19 infections. Patients with onset of anosmia or hyposmia should take the test or undergo screening for the possibility of COVID-19 infection.

Dipeptidyl peptidase 4 (DPP4) inhibitor and outcome from coronavirus disease 2019 (COVID-19) in diabetic patients: a systematic review, meta-analysis, and meta-regression

BACKGROUND

One of the drugs which is commonly used in diabetic patients is Dipeptidyl Peptidase-4 (DPP-4) inhibitor. Currently, the association between DPP-4 inhibitor and coronavirus disease 2019 (COVID-19) outcome is not yet established. This study aims to analyze the potential association between DPP-4 inhibitor and the composite poor outcome of COVID-19.

METHODS

We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until November 29th, 2020. All articles published on COVID-19 and DPP-4 inhibitor were retrieved. Statistical analysis was done using Review Manager 5.4 and Comprehensive Meta-Analysis version 3 software.

RESULTS

Our pooled analysis showed that DPP-4 inhibitor use was not associated with composite poor outcomes of COVID-19 [OR 1.09 (95% CI 0.93-1.28), p = 0.29, I 2 = 0%, random-effect modelling], and its subgroup which comprised of severe COVID-19 [OR 1.07 (95% CI 0.87-1.31), p = 0.54, I 2 = 0%, random-effect modelling], and mortality [OR 1.14 (95% CI 0.87-1.51), p = 0.35, I 2 = 8%, random-effect modelling]. Meta-regression showed that the association was not influenced by age (p = 0.663), hypertension (p = 0.454), and admission blood glucose (p = 0.310). Subgroup analysis showed that the association was weaker in East Asian populations (OR 1.02) compared to European populations (OR 1.11).

CONCLUSION

DPP-4 inhibitor in diabetic patients did not alter the outcomes from COVID-19. Our study suggest that the use of DPP-4 inhibitor in COVID-19 patients with diabetes may still be continued according to the patients' need.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40200-021-00777-4.

Vitamin D supplementation and Covid‐19 outcomes: A systematic review, meta‐analysis and meta‐regression

Vitamin D has many protective properties and potential role against acute lung injury. Low serum vitamin D is associated with high risk of pneumonia and development of acute respiratory distress syndrome. This study sought to analyse the efficacy of vitamin D in improving the outcomes of coronavirus disease 2019 (Covid‐19) patients. Using specific keywords, we comprehensively searched the potential articles on PubMed, Europe PMC and ClinicalTrials.gov database until 8th May 2021. All published studies on Covid‐19 and vitamin D were retrieved. Statistical analysis was conducted using Review Manager 5.4 software. A total of 11 studies with 22,265 Covid‐19 patients were included in the meta‐analysis. Our data suggested that vitamin D supplementation was associated with reduction in intensive care unit admission rate (OR 0.27; 95% CI: 0.09–0.76, p  = 0.010, I 2 = 70%, random‐effect modelling); reduction of the need for mechanical ventilation (OR 0.34; 95% CI: 0.16–0.72, p  = 0.005, I 2 = 61%, random‐effect modelling) and reduction of mortality from Covid‐19 (OR 0.37; 95% CI: 0.21–0.66, p  < 0.001, I 2 = 50%, random‐effect modelling). Further analysis showed that the associations were influenced by age (p  = 0.020). Our study suggests that vitamin D supplementation may offer beneficial effects on Covid‐19 outcomes. However, more randomized clinical trials are required to confirm this conclusion.

Efficacy of Lopinavir/Ritonavir Compared With Standard Care for Treatment of Coronavirus Disease 2019 (COVID-19): A Systematic Review

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a newly discovered multi-organ disease caused by the novel coronavirus SARS-CoV-2. Currently, there are no official guidelines on the pharmacological treatment of COVID-19. Lopinavir/ritonavir is a licensed antiviral treatment against HIV and has shown activity against other coronaviruses.

OBJECTIVE

In this study, we review the evidence of the use of lopinavir/ritonavir as a potential treatment candidate against COVID-19.

METHODS

This systematic review has been registered in PROSPERO (CRD42020182067). A systematic search of the literature for the observational and randomized controlled trial was conducted in PubMed, PubMed Central, and Google Scholar through May 2nd, 2020. Two reviewers were independently searched and selected. The risk of bias was evaluated using the Jadad scale, Newcastle- Ottawa Quality assessment tool, and the National Institute of Health quality assessment tool.

RESULTS

A total of 1,965 articles were screened, from which 6 articles were selected. Of 6 articles that were included in this study, 4 reported no significant benefit in clinical improvement with lopinavir/ ritonavir when compared to standard care of treatment, while 2 studies reported otherwise. Lopinavir/ritonavir was also not associated with a reduction of 28-day mortality rate as reported by 1 included study. Most included studies reported gastrointestinal symptoms as side effects from lopinavir/ritonavir therapy.

CONCLUSION

There is not yet enough evidence to support the regular use of lopinavir/ritonavir in the treatment of COVID-19. Further clinical trials are needed to evaluate lopinavir/ritonavir's efficacy in treatment.

The Effectiveness and Safety of Remdesivir for the Treatment of Patients With COVID-19: A Systematic Review and Meta-Analysis

Background:

Coronavirus disease 2019 (COVID-19) is a pandemic disease that has significant implications on the global health burden. Currently, there is no widely accepted pharmacologic treatment for COVID-19. Remdesivir has been shown effective against various types of viruses, including coronaviruses. This study aimed at synthesizing the latest evidence regarding the effectiveness and safety of remdesivir as a potential treatment candidate against COVID-19.

Methods:

This systematic review has been registered in PROSPERO (CRD42020183707). A systematic search of the literature was conducted in PubMed, PubMed Central, and Google Scholar through June 5th, 2020. Statistical analysis was done by using the Review Manager 5.4 tool. The risk of bias was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and GRADE analysis was performed to determine the certainty of the evidence.

Results:

Two studies with a total of 1,300 patients were included. Meta-analysis showed that remdesivir was associated with faster time to clinical improvement (MD -4.75 days; 95% CI -4.84 days to -4.65 days; p < 0.00001), reduction in mortality rate (RR 0.39; 95% CI 0.27 – 0.56; p < 0.00001) and fewer incidence of serious adverse events (RR 0.77; 95% CI 0.63 – 0.94; p = 0.01). GRADE analysis showed a high certainty for serious adverse events and moderate certainty for time to clinical improvement and mortality rate.

Conclusion:

Remdesivir is more effective and safer compared with standard care of treatment for the treatment of COVID-19 because it was associated with faster time to clinical improvement, reduction in mortality rate, and fewer incidence of serious adverse events.

The Use of ACE inhibitor/ARB in SARS-CoV-2 Patients: A Comprehensive Narrative Review

The three most common comorbidities that are associated with increased mortality in COVID-19 patients are Hypertension, Diabetes, and Cardiovascular disease, Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARB) are the drugs most commonly prescribed for the management of these diseases. Recent experimental study in animals and humans have found that SARS-CoV-2 uses ACE2 as the receptors for entry. Moreover, in an animal study, the use of ACE inhibitor/ARB increases the level of ACE2 expression that can lead to increased SARS-CoV-2 infectivity. On the other side, some evidences suggest that the ACE2 receptor is not necessary for SARS-CoV-2 entry into the cell and suggested that there is a cofactor that play part. Experimental studies in humans also showed that there is no association between ACE inhibitor/ARB with SARS-CoV-2 infectivity and mortality. In conclusion, there is still insufficient data to stop the use of inhibitor/ARB in SARS-CoV-2 patients. Therefore, we suggested that in line with the recommendations from ESC and AHA/ACC, the use of these two drugs in SARS-CoV-2 patients with cardiovascular comorbidity should still be continued.

Ivermectin and outcomes from Covid‐19 pneumonia: A systematic review and meta‐analysis of randomized clinical trial studies

Ivermectin is an FDA‐approved drug for a parasitic disease that has broad antiviral activity. This study aims to analyse the efficacy of ivermectin in improving the Covid‐19 outcomes. We systematically searched the PubMed, Europe PMC and ClinicalTrials.gov database using specific keywords related to our aims until 10th May 2021. All published randomized clinical trial studies on Covid‐19 and ivermectin were retrieved. The quality of the study was assessed using Jadad scale assessment tool for clinical trial studies. Statistical analysis was done using Review Manager 5.4 software. A total of 19 studies with 2768 Covid‐19 patients were included in this meta‐analysis. This meta‐analysis showed that ivermectin was associated with reduction in severity of Covid‐19 (RR 0.43 [95% CI 0.23–0.81], p  = 0.008), reduction of mortality (RR 0.31 [95% CI 0.15–0.62], p  = 0.001), higher negative RT‐PCR test results rate (RR 1.23 [95% CI 1.01–1.51], p  = 0.04), shorter time to negative RT‐PCR test results (mean difference [MD] −3.29 [95% CI −5.69, −0.89], p  = 0.007), higher symptoms alleviations rate (RR 1.23 [95% CI 1.03−1.46], p  = 0.02), shorter time to symptoms alleviations (MD −0.68 [95% CI −1.07, −0.29], p  = 0.0007) and shorter time to hospital discharge (MD −2.66 [95% CI −4.49, −0.82], p  = 0.004). Our study suggests that ivermectin may offer beneficial effects towards Covid‐19 outcomes. More randomized clinical trial studies are still needed to confirm the results of our study.

Insulin Therapy and Outcome of Coronavirus Disease 2019 (COVID-19): A Systematic Review, Meta-Analysis, and Meta-Regression

BACKGROUND

Currently, the relationship between insulin therapy and COVID-19 outcome is not yet established. Our study aims to evaluate the possible association between insulin and the composite poor outcome of COVID-19.

METHODS

We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 12th, 2020. All articles published on COVID-19 and insulin were retrieved. Statistical analysis was done using Review Manager 5.4 and Comprehensive Meta-Analysis version 3 software.

RESULTS

Our pooled analysis showed that insulin use was associated with composite poor outcomes of COVID-19 [OR 2.06 (95% CI 1.70 - 2.48), p < 0.00001, I2 = 83%, random-effect modelling], and its subgroup which comprised of risk of COVID-19 [OR 1.70 (95% CI 1.40 - 2.08), p < 0.00001, I2 = 34%, random-effect modelling], severe COVID-19 [OR 2.30 (95% CI 1.60 - 3.30), p < 0.00001, I2 = 88%, random-effect modelling], and mortality [OR 2.14 (95% CI 1.47 - 3.10), p < 0.0001, I2 = 85%, random-effect modelling]. Meta-regression showed that the association was influenced by age (p = 0.008), but not by diabetes p = 0.423) and cardiovascular disease (p = 0.086).

CONCLUSION

Physicians should be more aware and take extra precautions with diabetes patients who use insulin therapy.