Association Between Preadmission Acid Suppressive Medication Exposure and Severity of Illness in Patients Hospitalized With COVID-19
MD B Joseph Elmunzer, Bethany J Wolf, James M Scheiman, William M Tierney, Jason R Taylor, MBBS Ambreen A Merchant, Vaishali A Patel, Field F Willingham, RN, BSN Eric F Howard, RN Mary K West, BS Casey L Koza, MD Patrick S Yachimski, MD, MPH Emad Qayed, Rosemary Nustas, MD Ali Zakaria, MD, MSc Marc S Piper, MD Lujain Jaza, MD Nauzer Forbes, BSc Millie Chau, MD Luis F Lara, MD Georgios I Papachristou, Uchechi Okafor, MD, MSc Darwin L Conwell, MD, MSc Michael L Volk, MD Evan Mosier, MD Mohamed Azab, MD Anish A Patel, MD Liam G Hilson, MD Selena Zhou, MD James Buxbaum, MD Vladimir M Kushnir, BS Alexandria M Lenyo, BS Ian P Sloan, RN, BSN Thomas Hollander, BS Caroline G Mcleod, MPH Rebecca L Spitzer, MHA Lauren Wakefield, MHA Haley Nitchie, MBBS, MPH Collins O Ordiah, MD Don C Rockey, BA Teldon B Alford, MD, MPH Sunil Amin, MD, MPH Gabriela N Kuftinec, MD Amar R Deshpande, MD, MPH Dhiraj Yadav, MS Melissa Saul, BS Melanie Mays, PhD Gulsum Anderson, Kelley Wood, BS Laura Mathews, MD Charlie Fox, MD, MS Jennifer M Kolb, MD Sachin Wani, MD Swati Pawa, MD Rishi Pawa, Andrew Canakis, MD Christopher Huang, MD Laith H Jamil, MD Andrew M Aneese, MD V Mihajlo Gjeorgjievski, MD Zaid Imam, MD Fadi Odish, MD Ahmed I Edhi, Molly Orosey, MD Abhinav Tiwari, MBBS Soumil Patwardhan, BA Benita K Glamour, DO, Zachary L Smith, MD Amy E Hosmer, RN Nancy Furey, MD Amitabh Chak, MMS Katherine A Hanley, Jordan Wood, MD, MS Rajesh N Keswani, MBBS Harsh K Patel, MD Janak N Shah, Emil Agarunov, MD Nicholas G Brown, MD Anish A Patel, MD Amrita Sethi, MD, MSc Evan L Fogel, RN, BSN Gail Mcnulty, MD Abdul Haseeb, MD Judy A Trieu, BS Rebekah E Dixon, Jeong Yun Yang, Christopher J Dimaio, Robin B Mendelsohn, Delia Calo, Olga C Aroniadis, Joseph F Lacomb, Lilian Cruz, Olga Reykhart, Bryan G Sauer, Galina Diakova, Duyen T Dang, Cyrus R Piraka, Eric D Shah, Molly Caisse, Natalia H Zbib, John A Damianos, Heiko Pohl, Stephanie Mitchell, Michael S Bronze, Ashwinee Condon, Adrienne Lenhart, Raman Muthusamy, Kulwinder S Dua, Vikram S Kanagala, James Esteban, Ayesha Kamal, Marcia I Canto, Vikesh K Singh, Maria Ines Pinto-Sanchez, Joy M Hutchinson, Richard S Kwon, Sheryl J Korsnes, Akbar K Waljee, Weijing Tang, Yueyang Zhang, Ji Zhu, Harminder Singh, Zahra Solati, Nick Hajidiacos
Gastroenterology, doi:10.1053/j.gastro.2020.11.007
R ecent studies have suggested that proton pump inhibitor (PPI) use may increase the risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and worsen the course COVID-19. 1, 2 This observation is biologically plausible, as gastric acid is a wellestablished line of defense against microbial pathogens, including SARS-CoV-1. 3 In addition, PPI use may worsen outcomes in patients with COVID-19 through alterations of the gut microbiome and intestinal immune apparatus. 4 Conversely, recent data suggest that histamine 2 receptor antagonists (H2RAs), which are less potent than PPIs in terms of acid suppression, may be beneficial in SARS-CoV-2 5,6 through direct antiviral effects. 7 Considering that acid suppressive medications are among the most commonly consumed drugs in the United States, an understanding of the impact of these agents on COVID-19 outcomes is of significant importance. In particular, data informing the public on whether there is an evidence-based rationale to modify the use of these chronic medications during the pandemic are necessary. We studied whether preadmission exposure to PPIs or H2RAs was associated with worse outcomes among patients hospitalized with COVID-19.
Methods This was a secondary analysis of a retrospective cohort study aiming to better characterize digestive manifestations in patients hospitalized with COVID-19 across 36 medical centers in North America. 8 The first 50 to 100 consecutive patients with a confirmed diagnosis of COVID-19 at each participating institution were included. Clinical data from the time of symptom onset until discharge, death, or the end of the study period were manually abstracted from electronic health records by study personnel under the oversight of a primary clinician-investigator. Conventional regression and propensity score matched analyses were performed to evaluate the association between preadmission acid suppressive medication exposure and mechanical ventilation or death. Sensitivity analyses were conducted to evaluate the validity of excluding patients with unknown PPI/H2RA status and of imputing missing data. More comprehensive methods are provided in the Supplementary Material.
DMC19 Registry Instructions 4_17_20 1) Please complete the below data collection form (DCF) in REDCap at the time of discharge or death. Data will appear in the DMC19 database once entry and verification are complete. 2) We aim to capture inpatients with a confirmed COVID-19 diagnosis, regardless of whether they have digestive manifestations. After prevalence is defined in hospitalized patients, and as the numbers grow, we may focus on patients who are known to have GI manifestations and/or include outpatients. 3) Please make all efforts to collect data on the first 50 to 100 consecutive patients at your hospital or health system. 4) Eligible patients can and should be identified by any means necessary, which may include, but is not limited to, institutional laboratory records, data warehouse queries, electronic health record research subject identification tools/dashboards, and discussions with the infectious disease or critical care services, etc. You may elect to use the emergency ICD-10 code of U07.1 -2019-nCov acute respiratory diseaseto help identify eligible patients. 5) Please triple-check data for accuracy before submission. Although we are performing central data monitoring, we cannot verify incoming data against source documents, nor are we performing on-site monitoring visits. Therefore, the overall quality of the data is assured primarily at the site level. 6) Along the lines of #5, coordinators should confer with a clinician during data collection to ensure that..
References
Almario, None, Am J Gastroenterol
Aroniadis, Msc, Lacomb, Cruz, Reykhart et al., University of Virginia Medical School
Darnell, None, J Virol Methods
Elmunzer, None, Clin Gastroenterol Hepatol
Freedberg, None, Gastroenterology
Freedberg, None, Gastroenterology
Joseph Elmunzer, Wolf, Phd, Elmunzer, Md et al., Writing committee
Lee, None, Gut
Mather, None, Am J Gastroenterol
Wu, None, Acta Pharm Sin B
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