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Loucera C, Carmona R, Esteban-Medina M, Bostelmann G, Muñoyerro-Muñiz D, Villegas R, Peña-Chilet M, Dopazo J. Real-world evidence with a retrospective cohort of 15,968 COVID-19 hospitalized patients suggests 21 new effective treatments. Virol J 2023; 20:226. [PMID: 37803348 PMCID: PMC10559601 DOI: 10.1186/s12985-023-02195-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
PURPOSE Despite the extensive vaccination campaigns in many countries, COVID-19 is still a major worldwide health problem because of its associated morbidity and mortality. Therefore, finding efficient treatments as fast as possible is a pressing need. Drug repurposing constitutes a convenient alternative when the need for new drugs in an unexpected medical scenario is urgent, as is the case with COVID-19. METHODS Using data from a central registry of electronic health records (the Andalusian Population Health Database), the effect of prior consumption of drugs for other indications previous to the hospitalization with respect to patient outcomes, including survival and lymphocyte progression, was studied on a retrospective cohort of 15,968 individuals, comprising all COVID-19 patients hospitalized in Andalusia between January and November 2020. RESULTS Covariate-adjusted hazard ratios and analysis of lymphocyte progression curves support a significant association between consumption of 21 different drugs and better patient survival. Contrarily, one drug, furosemide, displayed a significant increase in patient mortality. CONCLUSIONS In this study we have taken advantage of the availability of a regional clinical database to study the effect of drugs, which patients were taking for other indications, on their survival. The large size of the database allowed us to control covariates effectively.
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Affiliation(s)
- Carlos Loucera
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
| | - Rosario Carmona
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS. Hospital Virgen del Rocio, Sevilla, Spain
| | - Marina Esteban-Medina
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
| | - Gerrit Bostelmann
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
| | - Dolores Muñoyerro-Muñiz
- Subdirección Técnica Asesora de Gestión de la Información. Servicio Andaluz de Salud, Sevilla, Spain
| | - Román Villegas
- Subdirección Técnica Asesora de Gestión de la Información. Servicio Andaluz de Salud, Sevilla, Spain
| | - María Peña-Chilet
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS. Hospital Virgen del Rocio, Sevilla, Spain
| | - Joaquín Dopazo
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain.
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS. Hospital Virgen del Rocio, Sevilla, Spain.
- FPS/ELIXIR-ES, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, Sevilla, Spain.
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Kim B, Jung JH, Han K, Kang S, Lee E, Chung H, Kim SG, Cho SJ. Histamine-2 Receptor Antagonists and Proton Pump Inhibitors Are Associated With Reduced Risk of SARS-CoV-2 Infection Without Comorbidities Including Diabetes, Hypertension, and Dyslipidemia: A Propensity Score-Matched Nationwide Cohort Study. J Korean Med Sci 2023; 38:e99. [PMID: 37012686 PMCID: PMC10070049 DOI: 10.3346/jkms.2023.38.e99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/27/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND This study aimed to identify the effect of histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) use on the positivity rate and clinical outcomes of coronavirus disease 2019 (COVID-19). METHODS We performed a nationwide cohort study with propensity score matching using medical claims data and general health examination results from the Korean National Health Insurance Service. Individuals aged ≥ 20 years who were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 1 January and 4 June 2020 were included. Patients who were prescribed H2RA or PPI within 1 year of the test date were defined as H2RA and PPI users, respectively. The primary outcome was SARS-CoV-2 test positivity, and the secondary outcome was the instance of severe clinical outcomes of COVID-19, including death, intensive care unit admission, and mechanical ventilation administration. RESULTS Among 59,094 patients tested for SARS-CoV-2, 21,711 were H2RA users, 12,426 were PPI users, and 24,957 were non-users. After propensity score matching, risk of SARS-CoV-2 infection was significantly lower in H2RA users (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.74-0.98) and PPI users (OR, 0.62; 95% CI, 0.52-0.74) compared to non-users. In patients with comorbidities including diabetes, dyslipidemia, and hypertension, the effect of H2RA and PPI against SARS-CoV-2 infection was not significant, whereas the protective effect was maintained in patients without such comorbidities. Risk of severe clinical outcomes in COVID-19 patients showed no difference between users and non-users after propensity score matching either in H2RA users (OR, 0.89; 95% CI, 0.52-1.54) or PPI users (OR, 1.22; 95% CI, 0.60-2.51). CONCLUSION H2RA and PPI use is associated with a decreased risk for SARS-CoV-2 infection but does not affect clinical outcome. Comorbidities including diabetes, hypertension, and dyslipidemia seem to offset the protective effect of H2RA and PPI.
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Affiliation(s)
- Bokyung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, The Catholic University College of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Seungkyung Kang
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eunwoo Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunsoo Chung
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Jeong Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Shafrir A, Benson AA, Katz LH, Hershcovici T, Bitan M, Paltiel O, Calderon-Margalit R, Safadi R, Shauly-Aharonov M. The Association Between Proton Pump Inhibitors and COVID-19 is Confounded by Hyperglycemia in a Population-Based Study. Front Pharmacol 2022; 13:791074. [PMID: 35185561 PMCID: PMC8854493 DOI: 10.3389/fphar.2022.791074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background and Aims: There is conflicting evidence regarding the association between proton pump inhibitors (PPI) and the risk of acquisition and severity of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Aim: To evaluate the association between PPI exposure and infection and development of severe disease in patients infected with SARS-CoV2in a large population-based historical cohort. Methods: Data were extracted from a health maintenance organization database in Israel that insures over 1,200,000 individuals from across the country. All patients who underwent SARS-CoV-2 testing between March and November 2020 were included. Logistic regression and matched analyses were used to compare patients prescribed and exposed to PPIs to those not prescribed PPIs regarding SARS-CoV-2 positivity. In addition, among SARS-CoV-2 positive patients (n = 44,397) the likelihood of developing severe disease, defined by a composite endpoint of death, ICU admission and prolonged hospitalization, was compared in those exposed and not exposed to PPIs. Results: Among 255,355 adult patients who underwent SARS-CoV-2 testing by PCR, 44,397 (17.4%) were positive for SARS-CoV-2 and 12,066 (4.7%) patients were prescribed PPIs in the 3 months before testing. In a multivariable logistic regression model controlling for age, gender, smoking status, BMI, diabetes mellitus, hypertension, COPD, history of ischemic heart disease and fasting blood glucose (FBG) levels, no significant association was found between PPIs and SARS-CoV-2 positivity (p = 0.09 aOR 0.94, 95% CI – 0.88–1.01). Among SARS-CoV-2 positive patients, 910 (2%) had a severe infection. Multivariate logistic regression controlling for the abovementioned confounders, showed no such association between PPIs and severe COVID-19 (p = 0.28). Elevated FBG levels were significantly associated with both PPI exposure (p < 0.001) and severe COVID-19 infection (p < 0.001). These results were reinforced by a matched analysis (n = 655 pairs). Conclusion: PPIs are spuriously associated with severe COVID-19 due to the presence of elevated FBG as a confounder. Our study accounted for the FBG levels of patients and known risk factors for severe COVID-19 infection, which may be the reason for the discrepancy in prior studies. These results may aid in understanding potential confounders when evaluating potential associations of PPIs with other respiratory or viral diseases.
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Affiliation(s)
- Asher Shafrir
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Meuhedet Health Medical Organization, Jerusalem, Israel
- Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Ariel A. Benson
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Lior H. Katz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
- *Correspondence: Lior H. Katz,
| | - Tiberiu Hershcovici
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Menachem Bitan
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Meuhedet Health Medical Organization, Jerusalem, Israel
| | - Ora Paltiel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Hematology, Hadassah University Medical Center, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rifaat Safadi
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Michal Shauly-Aharonov
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Jerusalem College of Technology, Jerusalem, Israel
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Kuno T, Miyamoto Y, Iwagami M, Ishimaru M, So M, Takahashi M, Egorova NN. The association of hemoglobin drop with in-hospital outcomes in COVID-19 patients. QJM 2022; 114:789-794. [PMID: 34597401 PMCID: PMC8500138 DOI: 10.1093/qjmed/hcab251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/16/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Bleeding events can be critical in hospitalized patients with COVID-19, especially those with aggressive anticoagulation therapy. AIM We aimed to investigate whether hemoglobin drop was associated with increased risk of acute kidney injury (AKI) and in-hospital mortality among patients with COVID-19. DESIGN Retrospective cohort study. METHODS This retrospective study was conducted by review of the medical records of 6683 patients with laboratory-confirmed COVID-19 hospitalized in the Mount Sinai Health system between 1st March 2020 and 30th March 2021. We compared patients with and without hemoglobin drop >3 g/dl during hospitalization within a week after admissions, using inverse probability treatment weighted analysis (IPTW). Outcomes of interest were in-hospital mortality and AKI which was defined as serum creatine change of 0.3 mg/dl increase or 1.5 times baseline. RESULTS Of the 6683 patients admitted due to COVID-19, 750 (11.2%) patients presented with a marked hemoglobin drop. Patients with hemoglobin drop were more likely to receive therapeutic anticoagulation within 2 days after admissions. Patients with hemoglobin drop had higher crude in-hospital mortality (40.8% vs. 20.0%, P < 0.001) as well as AKI (51.4% vs. 23.9%, P < 0.001) compared to those without. IPTW analysis showed that hemoglobin drop was associated with higher in-hospital mortality compared to those without (odds ratio (OR) [95% confidential interval (CI)]: 2.21 [1.54-2.88], P < 0.001) as well as AKI (OR [95% CI]: 2.79 [2.08-3.73], P < 0.001). CONCLUSIONS Hemoglobin drop during COVID-19 related hospitalizations was associated with a higher risk of AKI and in-hospital mortality.
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Affiliation(s)
- Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA
- Address for correspondence: Toshiki Kuno, MD, PhD, Division of Cardiology, Montefiore Medical Center, Albert Einsten College of Medicine, 111 East 210th St, Bronx, NY 10467-2401,
| | | | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Miho Ishimaru
- Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Matsuo So
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Mai Takahashi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, USA
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Zippi M, Fiorino S, Budriesi R, Micucci M, Corazza I, Pica R, de Biase D, Gallo CG, Hong W. Paradoxical relationship between proton pump inhibitors and COVID-19: A systematic review and meta-analysis. World J Clin Cases 2021; 9:2763-2777. [PMID: 33969059 PMCID: PMC8058681 DOI: 10.12998/wjcc.v9.i12.2763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/01/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The proton pump inhibitors (PPIs), used to reduce gastric acid secretion, represent one of the most widely used pharmaceutical classes in the world. Their consumption as a risk factor for the evolution of severe forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been investigated as well as the mortality of these patients. These risks also appear to be linked to the duration and the dosage. On the other hand, several studies have emerged with regard to the protective or therapeutic effects of these drugs. More and more evidence underlines the immunomodulatory and anti-fibrotic role of PPIs. In addition, their ability to alkalize the contents of endosomes and lysosomes serves as an obstacle to the entry of the virus into the host cells. AIM To identify studies on the relationship between the intake of PPIs and coronavirus disease 2019 (COVID-19) in patients affected by SARS-CoV-2 infection, with the main objective of evaluating the outcomes related to severity and mortality. METHODS A literature review was performed in November 2020. The MEDLINE/PubMed, Cochrane Library, EMBASE and Google Scholar databases were searched for all relevant articles published in English on this topic. The search terms were identified by means of controlled vocabularies, such as the National Library of Medicine's MESH (Medical Subject Headings) and keywords. The MESH terms and keywords used were as follows: "COVID-19", "proton pump inhibitors", "PPIs", "SARS-CoV-2", "outcomes", "severity" and "mortality". The inclusion criteria regarding the studies considered in our analysis were: meta-analysis, case-control, hospital-based case-control, population-based case-control, retrospective studies, online survey, as well as cohort-studies, while articles not published as full reports, such as conference abstracts, case reports and editorials were excluded. We tried to summarize and pool all the data if available. RESULTS A total of 9 studies were found that described the use of PPIs, of which only 5 clearly reported the severity and mortality data in SARS-CoV-2 patients. Our pooled incidence analysis of severe events did not differ between patients with and without PPIs (odds ratio 1.65, 95% confidence interval: 0.62-4.35) (P = 0.314), or for mortality (odds ratio 1.77, 95% confidence interval: 0.62-5.03) (P = 0.286). CONCLUSION Detailed and larger case studies are needed to accurately understand the role of PPIs in this viral infection.
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Affiliation(s)
- Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome 00157, Italy
| | - Sirio Fiorino
- Unit of Internal Medicine, Maggiore Hospital, Local Health Unit of Bologna, Bologna 40133, Italy
| | - Roberta Budriesi
- Food Chemistry and Nutraceuticals Laboratory, Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum, University of Bologna, Bologna 40133, Italy
| | - Matteo Micucci
- Food Chemistry and Nutraceuticals Laboratory, Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum, University of Bologna, Bologna 40133, Italy
| | - Ivan Corazza
- Experimental, Diagnostic and Speciality Medicine Department, University of Bologna, Bologna 40138, Italy
| | - Roberta Pica
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome 00157, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna 40138, Italy
| | | | - Wandong Hong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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Homolak J, Kodvanj I, Trkulja V. An Additional Perspective on Proton Pump Inhibitors as Risk Factors for COVID-19. Clin Drug Investig 2021; 41:287-289. [PMID: 33606199 PMCID: PMC7892720 DOI: 10.1007/s40261-021-01007-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jan Homolak
- Department of Pharmacology, University of Zagreb School of Medicine, 10 000, Zagreb, Croatia.
| | - Ivan Kodvanj
- Department of Pharmacology, University of Zagreb School of Medicine, 10 000, Zagreb, Croatia
| | - Vladimir Trkulja
- Department of Pharmacology, University of Zagreb School of Medicine, 10 000, Zagreb, Croatia
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Zhang XY, Li T, Wu H, Ling Y, Qian ZP, Chen L. Analysis of the Effect of Proton-Pump Inhibitors on the Course of COVID-19. J Inflamm Res 2021; 14:287-298. [PMID: 33574690 PMCID: PMC7872926 DOI: 10.2147/jir.s292303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/14/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study is to evaluate the effect of proton-pump inhibitors on the course of COVID-19. METHODS Clinical data of moderate COVID-19 patients admitted to the Shanghai Public Health Clinical Center for treatment from January 20, 2020, to March 16, 2020, were collected. A retrospective study was conducted and the patients were divided into two groups according to whether they used proton-pump inhibitors or not. The differences in SARS-CoV-2 clearance and hospital stay between the two groups were compared by Cox proportional hazards (PH) regression models and the propensity score matching method. RESULTS A total of 154 patients with moderate COVID-19 were included in this study, including 80 males (51.9%), 35 patients (22.7%) in the proton-pump inhibitor group, and 119 patients (77.3%) in the control group. In the proton-pump inhibitor group and the control group, the duration of the SARS-CoV-2 clearance was 7 days (95% CI, 6-9) and 7 days (95% CI, 6-11), and the duration of the hospital stay was 21 days (95% CI, 16-25) and 20 days (95% CI, 15-26), respectively. There was no significant difference between the both groups in the cumulative incidence of the SARS-CoV-2 clearance and the discharge, and the same results were obtained after the propensity score matching, all P > 0.05. There was no significant association between the use of proton-pump inhibitors and the duration of SARS-CoV-2 clearance, according to univariate analysis (HR, 1.309; 95% CI, 0.893-1.918) and multivariate analysis (HR, 1.575; 95% CI, 0.993-2.499). There was no significant association between the use of proton-pump inhibitors and the duration of hospital stay for COVID-19, according to univariate analysis (HR, 1.044; 95% CI, 0.714-1.528) and multivariate analysis (HR, 1.064; 95% CI, 0.651-1.740). CONCLUSION The use of proton-pump inhibitors has no effect on prolonging or shortening the course of adults hospitalized with COVID-19.
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Affiliation(s)
- Xiao-Yu Zhang
- Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Tao Li
- Department of Tuberculosis Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Haibing Wu
- Department of Neurosurgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Yun Ling
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Zhi-Ping Qian
- Department of Severe Hepatopathy, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Liang Chen
- Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
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Hunt RH, East JE, Lanas A, Malfertheiner P, Satsangi J, Scarpignato C, Webb GJ. COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist. Dig Dis 2020; 39:119-139. [PMID: 33040064 PMCID: PMC7705947 DOI: 10.1159/000512152] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND COVID-19 was initially considered a respiratory disease but the SARS-CoV-2 virus can lead to serious systemic consequences affecting major organs including the digestive system. SUMMARY This review brings new clinically important information for the gastroenterologist. This includes: the mechanisms of tissue damage seen with the SARS-CoV-2 virus; the consequences of immunosuppression in patients with inflammatory bowel disease (IBD) and chronic liver disease with the additional risks of decompensation in patients with cirrhosis; the impact of COVID-19 on gastrointestinal emergencies, on gastrointestinal endoscopy, diagnosis and treatments. These highlight the need to understand the clinical pharmacology, toxicology and therapeutic implications of drugs commonly used by gastroenterologists and their links with COVID-19. Key Messages: Any part of the digestive system may be affected by the SARS-CoV-2 virus, and those with pre-existing disease are at greatest risk of adverse outcomes. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who often require mechanical ventilation and life support. Some repurposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19-related gastrointestinal symptoms and can also induce liver injury. Ongoing clinical studies will hopefully identify effective drugs with a more favourable risk-benefit ratio than many initially tried treatments.
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Affiliation(s)
- Richard H. Hunt
- Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada,*Richard H. Hunt, Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University Health Sciences Centre, Hamilton, ON L8S 4L8 (Canada),
| | - James E. East
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Angel Lanas
- University Hospital Lozano Blesa, IIS Aragón, CIBER Enfermedades Hepáticas y Digestivas (CIBERehd) Digestive Diseases, Universidad de Zaragoza, Zaragoza, Spain
| | - Peter Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Magdeburg, Germany,Med. Klinik und Poliklinik II, Klinikum der Universität, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jack Satsangi
- Consultant Physician, Oxford University NHS Trust and Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom,Department of Gastroenterology, University of Edinburgh, Edinburgh, United Kingdom
| | - Carmelo Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta,Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Gwilym J. Webb
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom
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