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Association between prior cardiometabolic therapy and in-hospital mortality in very old patients with type 2 diabetes mellitus hospitalized due to COVID-19. A nationwide observational study in Spain

Ramos-Rincón et al., Research Square, doi:10.21203/rs.3.rs-133358/v1
Dec 2020  
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0 0.5 1 1.5 2+ Mortality -29% Improvement Relative Risk Aspirin for COVID-19  Ramos-Rincón et al.  Prophylaxis Is prophylaxis with aspirin beneficial for COVID-19? Retrospective 790 patients in Spain (March - May 2020) Higher mortality with aspirin (p=0.02) c19early.org Ramos-Rincón et al., Research Square, Dec 2020 Favors aspirin Favors control
Aspirin for COVID-19
24th treatment shown to reduce risk in August 2021
 
*, now known with p = 0.000087 from 73 studies, recognized in 3 countries.
Lower risk for mortality and progression.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,200+ studies for 70+ treatments. c19early.org
Retrospective 790 hospitalized type 2 diabetes patients ≥80 years old in Spain, showing higher mortality with existing aspirin use.
Study covers aspirin and metformin.
risk of death, 28.9% higher, RR 1.29, p = 0.02, treatment 132 of 264 (50.0%), control 253 of 526 (48.1%), adjusted per study, odds ratio converted to relative risk, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ramos-Rincón et al., 28 Dec 2020, retrospective, Spain, preprint, 25 authors, study period 1 March, 2020 - 29 May, 2020. Contact: luismiguelpb1984@gmail.com.
This PaperAspirinAll
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This work aims to analyze the association ' 'between preadmission cardiometabolic therapy (antidiabetic, antiaggregant, antihypertensive, ' 'and lipid-lowering drugs) and in-hospital mortality among patients\u2009≥\u200980 years with ' 'type 2 diabetes mellitus hospitalized for COVID-19.\n' 'Methods\n' '\n' 'We conducted a nationwide, multicenter, retrospective, observational study in patients\u2009' '≥\u200980 years with type 2 diabetes mellitus and COVID-19 hospitalized in 160 Spanish ' 'hospitals between March 1 and May 29, 2020 who were included in the SEMI-COVID-19 Registry. ' 'The primary outcome measure was in-hospital mortality. A multivariate logistic regression ' 'analysis were performed to assess the association between preadmission cardiometabolic ' 'therapy and in-hospital mortality. The regression analysis values were expressed as adjusted ' 'odds ratios (AOR) with a 95% confidence interval (CI). In order to select the variables, the ' 'forward selection Wald statistic was used. Discrimination of the fitted logistic model was ' 'assessed via a receiver operating characteristic (ROC) curve. The Hosmer-Lemeshow test for ' 'logistic regression was used to determine the model’s goodness of fit.\n' 'Results\n' '\n' 'Of the 2,763 patients ≥80 years old hospitalized due to COVID-19, 790 (28.6%) had T2DM. Of ' 'these patients, 385 (48.7%) died during admission. On the multivariate analysis, the use of ' 'dipeptidyl peptidase-4 inhibitors (AOR 0.502, 95% CI 0.309–0.815, p\u2009=\u20090.005) and ' 'angiotensin receptor blockers (AOR 0.454, 95% CI 0.274–0.759, p\u2009=\u20090.003) were ' 'independent protectors against in-hospital mortality whereas the use of acetylsalicylic acid ' 'was associated with higher in-hospital mortality (AOR 1.761, 95% CI 1.092–2.842, p\u2009' '=\u20090.020). Other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins ' 'showed neutral association with in-hospital mortality. The model showed an area under the ' 'curve of 0.788.\n' 'Conclusions\n' '\n' 'We found important differences between cardiometabolic drugs and in-hospital mortality in ' 'older patients with type 2 diabetes mellitus hospitalized for COVID-19. Preadmission ' 'treatment with dipeptidyl peptidase-4 inhibitors and angiotensin receptor blockers may reduce ' 'in-hospital mortality; other antidiabetic drugs, angiotensin-converting enzyme inhibitors and ' 'statins seem to have a neutral effect; and acetylsalicylic acid may be associated with excess ' 'mortality.</jats:p>', 'DOI': '10.21203/rs.3.rs-133358/v1', 'type': 'posted-content', 'created': { 'date-parts': [[2020, 12, 28]], 'date-time': '2020-12-28T21:58:47Z', 'timestamp': 1609192727000}, 'source': 'Crossref', 'is-referenced-by-count': 1, 'title': 'Association between prior cardiometabolic therapy and in-hospital mortality in very old patients ' 'with type 2 diabetes mellitus hospitalized due to COVID-19. A nationwide observational study in ' 'Spain', 'prefix': '10.21203', 'author': [ { 'given': 'Jose Manuel', 'family': 'Ramos-Rincón', 'sequence': 'first', 'affiliation': [ { 'name': 'Miguel Hernandez University of Elche: Universidad Miguel ' 'Hernandez de Elche'}]}, { 'ORCID': 'http://orcid.org/0000-0001-9512-8274', 'authenticated-orcid': False, 'given': 'Luis M', 'family': 'Pérez-Belmonte', 'sequence': 'additional', 'affiliation': [ { 'name': 'Hospital Regional Universitario de Málaga: Hospital Regional ' 'Universitario de Malaga'}]}, { 'given': 'Francisco Javier', 'family': 'Carrasco-Sánchez', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital Juan Ramón Jiménez: Hospital Juan Ramon Jimenez'}]}, { 'given': 'Sergio', 'family': 'Jansen-Chaparro', 'sequence': 'additional', 'affiliation': [ { 'name': 'Hospital Regional Universitario de Málaga: Hospital Regional ' 'Universitario de Malaga'}]}, { 'given': 'Mercedes', 'family': 'De-Sousa-Baena', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital Juan Ramón Jiménez: Hospital Juan Ramon Jimenez'}]}, { 'given': 'José', 'family': 'Bueno-Fonseca', 'sequence': 'additional', 'affiliation': [ { 'name': 'Hospital Regional Universitario de Málaga: Hospital Regional ' 'Universitario de Malaga'}]}, { 'given': 'Maria', 'family': 'Pérez-Aguilar', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital Juan Ramón Jiménez: Hospital Juan Ramon Jimenez'}]}, { 'given': 'Coral Arévalo', 'family': 'Cañas', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital 12 de Octubre Servicio de Medicina Interna'}]}, { 'given': 'Marta Bacete', 'family': 'Cebrian', 'sequence': 'additional', 'affiliation': [ { 'name': 'Hospital General Universitario Gregorio Marañón: Hospital ' 'General Universitario Gregorio Maranon'}]}, { 'given': 'Manuel', 'family': 'Méndez-Bailón', 'sequence': 'additional', 'affiliation': [ { 'name': 'San Carlos University Hospital Internal Medicine III Service: ' 'Hospital Clinico Universitario San Carlos Servicio de Medicina ' 'Interna III'}]}, { 'given': 'Isabel Fiteni', 'family': 'Mera', 'sequence': 'additional', 'affiliation': [{'name': 'Royo Villanova Hospital: Hospital Royo Villanova'}]}, { 'given': 'Andrés González', 'family': 'García', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital Ramon y Cajal: Hospital Universitario Ramon y Cajal'}]}, { 'given': 'Francisco Navarro', 'family': 'Romero', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital Costa del Sol'}]}, { 'given': 'Carlota Tuñón de', 'family': 'Almeida', 'sequence': 'additional', 'affiliation': [{'name': ': Complejo Asistencial de Zamora'}]}, { 'given': 'Gemma Muñiz', 'family': 'Nicolás', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital Virgen de la Salud'}]}, { 'given': 'Amara González', 'family': 'Noya', 'sequence': 'additional', 'affiliation': [ { 'name': 'Complejo Hospitalario de Orense: Complexo Hospitalario de ' 'Ourense'}]}, { 'given': 'Almudena Hernández', 'family': 'Milian', 'sequence': 'additional', 'affiliation': [ { 'name': 'Hospital Universitario Son Espases: Hospital Universitari Son ' 'Espases'}]}, { 'given': 'Gema María García', 'family': 'García', 'sequence': 'additional', 'affiliation': [{'name': 'Complejo Hospitalario Universitario de Badajoz'}]}, { 'given': 'José Nicolás Alcalá', 'family': 'Pedrajas', 'sequence': 'additional', 'affiliation': [{'name': 'VS Hospital'}]}, { 'given': 'Virginia Herrero', 'family': 'García', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital Doctor Jose Molina Orosa'}]}, { 'given': 'Luis', 'family': 'Corral-Gudino', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital Universitario Rio Hortega'}]}, { 'given': 'Pere Comas', 'family': 'Casanova', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital de Blanes'}]}, { 'given': 'Héctor Meijide', 'family': 'Míguez', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital QuironSalud A Coruña'}]}, { 'given': 'José Manuel', 'family': 'Casas-Rojo', 'sequence': 'additional', 'affiliation': [{'name': 'Hospital Universitario Infanta Cristina'}]}, { 'given': 'Ricardo', 'family': 'Gómez-Huelgas', 'sequence': 'additional', 'affiliation': [ { 'name': 'Regional University Hospital of Malaga: Hospital Regional ' 'Universitario de Malaga'}]}], 'member': '8761', 'container-title': [], 'original-title': [], 'link': [ { 'URL': 'https://www.researchsquare.com/article/rs-133358/v1', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://www.researchsquare.com/article/rs-133358/v1.html', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2021, 3, 17]], 'date-time': '2021-03-17T17:11:49Z', 'timestamp': 1616001109000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.researchsquare.com/article/rs-133358/v1'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2020, 12, 28]]}, 'references-count': 0, 'URL': 'http://dx.doi.org/10.21203/rs.3.rs-133358/v1', 'relation': {}, 'published': {'date-parts': [[2020, 12, 28]]}, 'subtype': 'preprint'}
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