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Baldia PH, Wernly B, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Kelm M, Beil M, Bruno RR, Binnebößel S, Wolff G, Erkens R, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Leaver S, De Lange DW, Guidet B, Jung C, Joannidis M, Mesotten D, Reper P, Swinnen W, Serck N, DEWAELE ELISABETH, Brix H, Brushoej J, Kumar P, Nedergaard HK, Balleby IR, Bundesen C, Hansen MA, Uhrenholt S, Bundgaard H, Innes R, Gooch J, Cagova L, Potter E, Reay M, Davey M, Abusayed MA, Humphreys S, Galbois A, Charron C, Berlemont CH, Besch G, Rigaud JP, Maizel J, Djibré M, Burtin P, Garcon P, Nseir S, Valette X, Alexandru N, Marin N, Vaissiere M, PLANTEFEVE G, Vanderlinden T, Jurcisin I, Megarbane B, Chousterman BG, Dépret F, Garnier M, Besset S, Oziel J, Ferre A, Dauger S, Dumas G, Goncalves B, Vettoretti L, Thevenin D, Schaller S, Schaller S, Kurt M, Faltlhauser A, Schaller S, Milovanovic M, Lutz M, Shala G, Haake H, Randerath W, Kunstein A, Meybohm P, Schaller S, Steiner S, Barth E, Poerner T, Simon P, Lorenz M, Dindane Z, Kuhn KF, Welte M, Voigt I, Kabitz HJ, Wollborn J, Goebel U, Stoll SE, Kindgen-Milles D, Dubler S, Jung C, Fuest K, Schuster M, Papadogoulas A, Mulita F, Rovina N, Aidoni Z, CHRISANTHOPOULOU EVANGELIA, KONDILI EUMORFIA, Andrianopoulos I, Groenendijk M, Evers M, Evers M, van Lelyveld-Haas L, Meynaar I, Cornet AD, Zegers M, Dieperink W, de Lange D, Dormans T, Hahn M, Sjøbøe B, Strietzel HF, Olasveengen T, Romundstad L, Kluzik A, Zatorski P, Drygalski T, Klimkiewicz J, Solek-pastuszka J, Onichimowski D, Czuczwar M, Gawda R, Stefaniak J, Stefanska-Wronka K, Zabul E, Oliveira AIP, Assis R, de Lurdes Campos Santos M, Santos H, Cardoso FS, Gordinho A, Banzo MJA, Zalba-Etayo B, CUBERO PATRICIAJIMENO, Priego J, Gomà G, Tomasa-Irriguible TM, Sancho S, Ferreira AF, Vázquez EM, Mira ÁP, Ibarz M, Iglesias D, Arias-Rivera S, Frutos-Vivar F, Lopez-Cuenca S, Aldecoa C, Perez-Torres D, Canas-Perez I, Tamayo-Lomas L, Diaz-Rodriguez C, de Gopegui PR, Ben-Hamouda N, Roberti A, Fleury Y, Abidi N, Dullenkopf A, Pugh R, Smuts S. The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial. BMC Geriatr 2022; 22:1000. [PMID: 36575394 PMCID: PMC9794407 DOI: 10.1186/s12877-022-03709-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In the early COVID-19 pandemic concerns about the correct choice of analgesics in patients with COVID-19 were raised. Little data was available on potential usefulness or harmfulness of prescription free analgesics, such as paracetamol. This international multicentre study addresses that lack of evidence regarding the usefulness or potential harm of paracetamol intake prior to ICU admission in a setting of COVID-19 disease within a large, prospectively enrolled cohort of critically ill and frail intensive care unit (ICU) patients. METHODS This prospective international observation study (The COVIP study) recruited ICU patients ≥ 70 years admitted with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, prior paracetamol intake within 10 days before admission, ICU therapy, limitations of care and survival during the ICU stay, at 30 days, and 3 months. Paracetamol intake was analysed for associations with ICU-, 30-day- and 3-month-mortality using Kaplan Meier analysis. Furthermore, sensitivity analyses were used to stratify 30-day-mortality in subgroups for patient-specific characteristics using logistic regression. RESULTS 44% of the 2,646 patients with data recorded regarding paracetamol intake within 10 days prior to ICU admission took paracetamol. There was no difference in age between patients with and without paracetamol intake. Patients taking paracetamol suffered from more co-morbidities, namely diabetes mellitus (43% versus 34%, p < 0.001), arterial hypertension (70% versus 65%, p = 0.006) and had a higher score on Clinical Frailty Scale (CFS; IQR 2-5 versus IQR 2-4, p < 0.001). Patients under prior paracetamol treatment were less often subjected to intubation and vasopressor use, compared to patients without paracetamol intake (65 versus 71%, p < 0.001; 63 versus 69%, p = 0.007). Paracetamol intake was not associated with ICU-, 30-day- and 3-month-mortality, remaining true after multivariate adjusted analysis. CONCLUSION Paracetamol intake prior to ICU admission was not associated with short-term and 3-month mortality in old, critically ill intensive care patients suffering from COVID-19. TRIAL REGISTRATION This prospective international multicentre study was registered on ClinicalTrials.gov with the identifier "NCT04321265" on March 25, 2020.
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Affiliation(s)
- Philipp Heinrich Baldia
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Wernly
- grid.21604.310000 0004 0523 5263Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, Department of Anaestesia and Intensive Care, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Jesper Fjølner
- grid.154185.c0000 0004 0512 597XDepartment of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Critical Care Centre, Sabadell Hospital University Institute Parc Tauli, Sabadell Barcelona, Spain
| | - Bernardo Bollen Pinto
- grid.150338.c0000 0001 0721 9812Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C. Schefold
- grid.411656.10000 0004 0479 0855Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Malte Kelm
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Beil
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Romano Bruno
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stephan Binnebößel
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Georg Wolff
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ralf Erkens
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Sviri Sigal
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- grid.5522.00000 0001 2162 9631Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Muhammed Elhadi
- grid.411306.10000 0000 8728 1538Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- grid.410566.00000 0004 0626 3303Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- grid.411596.e0000 0004 0488 8430Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H. Andersen
- grid.5947.f0000 0001 1516 2393Department Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway. Dep. of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- grid.414551.00000 0000 9715 2430Multipurpose and Neurocritical Intensive Care Unit, Hospital of São José, Central Lisbon University Hospital Centre, Lisbon, Portugal
| | - Susannah Leaver
- grid.451349.eGeneral Intensive Care, St George´S University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W. De Lange
- grid.7692.a0000000090126352Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, Netherlands
| | - Bertrand Guidet
- Institute Pierre Louis Epidemiology and Public Health, Medical Intensive Care Unit, Sorbonne University, UPMC, INSERM, Hôpital Saint-Antoine, Paris, France
| | - Christian Jung
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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