Associations of comorbidities and medications with COVID-19 outcome: A retrospective analysis of real-world evidence data
Basel Abu-Jamous, Arseni Anisimovich, Janie Baxter, Lucy Mackillop, Marcela P Vizcaychipi, Alex Mccarthy, Rabia T Khan
doi:10.1101/2020.08.20.20174169
All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in Active arm: COVID-19 patients with the medication prescribed AFTER but NEVER BEFORE testing positive on COVID-19 Control arm: COVID-19 patients with no prescriptions of the medication AFTER testing positive on COVID-19 Active arm: COVID-19 patients with the medication prescribed AFTER but NEVER BEFORE testing positive on COVID-19 Control arm: COVID-19 patients with no prescriptions of the medication in their entire history COVID-19 positive result date Earliest observation in data Most recent observation In data 21 days 21 days End point: inpatient mortality Medications: short-term drugs End point: inpatient mortality Medications: short-term drugs Active arm: COVID-19 patients with the medication prescribed BOTH before and after testing positive on COVID-19 Control arm: COVID-19 patients with no prescriptions of the medication in their entire history 21 days End point: inpatient mortality Medications: long-term drugs COVID-19 test date Active arm: Patients with the medication prescribed within 30 days before their COVID-19 test but NEVER earlier Control arm: Patients with no prescriptions of the medication within 30 days before their COVID-19 test End point: COVID-19 positive presentation Medications: short-term drugs Active arm: Patients with the medication prescribed at least once within 180 before their COVID-19 test and at least once earlier than that Control arm: Patients with no prescriptions of the medication in their entire history End point: COVID-19 positive presentation Medications: long-term drugs 180 days Line of analysis ID PP-ST2 PP-LT M-ST1 M-ST2 M-LT Active arm: Patients with the medication prescribed within 30 days before their COVID-19 test but NEVER earlier Control arm: Patients with no prescriptions of the medication in their entire history
Consortium, comprising all critical care personnel who were part of the delivery of care during the COVID444 19 pandemic as follows: CW Anaesthetics Consultants, Critical Care Consultants, Trainees & Fellows from ICU, Anaesthesia, and seconded to ICU from other specialities, Surgeons, the supporting Respiratory and ED Physicians, Operating Department Practitioners and CW Critical Care Nurses. This united approach to an unprecedented clinical condition was critical not only to the management of the patients but also to our ability to document and collate the key data in a timely manner to support this analysis.
Compliance with ethical guidelines All methods were performed in accordance with the relevant guidelines and regulations. All analyses were conducted on data with no personal identifying information. Therefore, informed consent was waived by the ethics committee of the Chelsea & Westminster NHS Foundation Trust, which provided ethical approval for the study.
References
Atallah, Mallah, Almahmeed, Anticoagulation in COVID-19, European Heart Journal -Cardiovascular Pharmacotherapy
Chen, Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study, BMJ
Cure, Cure, Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID-19 pandemic, Diabetes & Metabolic Syndrome: Clinical Research & Reviews
Cure, Cure, Comment on "Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade, Nephron Clinical Practice
Perico, Benigni, Remuzzi, Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade, Nephron Clinical Practice
Quan, Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data, Medical Care
Tang, Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy, Journal of Thrombosis and Haemostasis
Vizcaychipi, Increase in COVID-19 inpatient survival following detection of Thromboembolic and Cytokine storm risk from the point of admission to hospital by a near real time Traffic-light System (TraCe-Tic), The Brazilian Journal of Infectious Diseases,
doi:10.1016/j.bjid.2020.07.010Wang, Epidemiology of 2019 novel coronavirus in Jiangsu Province, China after wartime control measures: A population-level retrospective study
Williams, Zhang, Hypertension, renin-angiotensin-aldosterone system inhibition, and COVID-19, LANCET
Yang, Prevalence of Comorbidities and Its Effects in Patients Infected With SARS-CoV-2: A Systematic Review and Meta-Analysis, Int J Infect Dis
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'abstract': '<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Hundreds '
'of thousands of deaths have already been recorded for patients with the severe acute '
'respiratory syndrome coronavirus (SARS-CoV-2; aka COVID-19). Understanding whether there is a '
'relationship between comorbidities and COVID-19 positivity will not only impact clinical '
'decisions, it will also allow an understanding of how better to define the long-term '
'complications in the groups at risk. In turn informing national policy on who may benefit '
'from more stringent social distancing and shielding strategies. Furthermore, understanding '
'the associations between medications and certain outcomes may also further our understanding '
'of indicators of vulnerability in people with COVID-19 and '
'co-morbidities.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Electronic '
'healthcare records (EHR) from two London hospitals were analysed between '
'1<jats:sup>st</jats:sup> January and 27<jats:sup>th</jats:sup> May 2020. 5294 patients '
'presented to the hospitals in whom COVID status was formally assessed; 1253 were positive for '
'COVID-19 and 4041 were negative. This dataset was analysed to identify associations between '
'comorbidities and medications, separately and two outcomes: (1) presentation with a COVID-19 '
'positive diagnosis, and (2) inpatient death following COVID-19 positive diagnosis. '
'Medications were analysed in different time windows of prescription to differentiate between '
'short-term and long-term medications. All analyses were done with controls (without '
'co-morbidity) matched for age, sex, and number of admissions, and a robustness approach was '
'conducted to only accept results that consistently appear when the analysis is repeated with '
'different proportions of the '
'data.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We observed higher '
'COVID-19 positive presentation for patients with hypertension (1.7 [1.3-2.1]) and diabetes '
'(1.6 [1.2-2.1]). We observed higher inpatient COVID-19 mortality for patients with '
'hypertension (odds ratio 2.7 [95% CI 1.9-3.9]), diabetes (2.2 [1.4-3.5]), congestive heart '
'failure (3.1 [1.5-6.4]), and renal disease (2.6 [1.4-5.1]). We also observed an association '
'with reduced COVID-19 mortality for diabetic patients for whom anticoagulants (0.11 '
'[0.03-0.50]), lipid-regulating drugs (0.15 [0.04-0.58]), penicillins (0.20 [0.06-0.63]), or '
'biguanides (0.19 [0.05-0.70]) were administered within 21 days after their positive COVID-19 '
'test with no evidence that they were on them before, and for hypertensive patients for whom '
'anticoagulants (0.08 [0.02-0.35]), antiplatelet drugs (0.10 [0.02-0.59]), lipid-regulating '
'drugs (0.15 [0.05-0.46]), penicillins (0.14 [0.05-0.45]), or angiotensin-converting enzyme '
'inhibitors (ARBs) (0.06 [0.01-0.53]) were administered within 21 days post-COVID-19-positive '
'testing with no evidence that they were on them before. Moreover, long-term antidiabetic '
'drugs were associated with reduced COVID-19 mortality in diabetic patients (0.26 '
'[0.10-0.67]).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>We '
'provided real-world evidence for observed associations between COVID-19 outcomes and a number '
'of comorbidities and medications. These results require further investigation and replication '
'in other data sets.</jats:p></jats:sec>',
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