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Insights from a multicenter nationwide cohort analysis in Japan on the association of underlying conditions and pharmacological interventions with COVID-19 disease severity

Sakamaki et al., Discover Public Health, doi:10.1186/s12982-024-00225-7
Sep 2024  
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Severe case -79% Improvement Relative Risk UDCA for COVID-19  Sakamaki et al.  Prophylaxis Is prophylaxis with ursodeoxycholic acid beneficial for COVID-19? Retrospective 650,317 patients in Japan (January 2020 - December 2022) Higher severe cases with ursodeoxycholic acid (p<0.000001) c19early.org Sakamaki et al., Discover Public Health, Sep 2024 FavorsUDCA Favorscontrol 0 0.5 1 1.5 2+
Retrospective 650,317 COVID-19 patients in Japan showing higher risk of severe COVID-19 with UDCA use. There may be significant residual confounding because authors do not appear to have adjusted for liver diseases (details of adjustments are not provided), and UDCA use is a strong indicator of certain liver conditions.
This study is excluded in the after exclusion results of meta analysis: significant unadjusted confounding possible.
Study covers metformin, ursodeoxycholic acid, and aspirin.
risk of severe case, 79.0% higher, OR 1.79, p < 0.001, adjusted per study, multivariable, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Sakamaki et al., 27 Sep 2024, retrospective, Japan, peer-reviewed, mean age 52.1, 3 authors, study period 15 January, 2020 - 31 December, 2022. Contact: andow@pharm.kitasato-u.ac.jp.
This PaperUDCAAll
Insights from a multicenter nationwide cohort analysis in Japan on the association of underlying conditions and pharmacological interventions with COVID-19 disease severity
Kyoka Sakamaki, Kiyoshi Shibuya, Wataru Ando
Discover Public Health, doi:10.1186/s12982-024-00225-7
Background In 2019, coronavirus disease 2019 (COVID-19) emerged in China, spreading globally with significant impacts in Japan, including the Delta and Omicron variants. The research identified risk factors such as age, chronic diseases, and lifestyle choices, emphasizing the need for further study on the association between underlying health conditions, treatments, and COVID-19 severity in Japan. Methods This study used a nationwide medical database to analyze the association between COVID-19 underlying conditions and pharmacological interventions to identify risk factors for disease severity. We examined the Japanese COVID-19 dataset from Medical Data Vision, selecting patients diagnosed with COVID-19 between January 2020 and December 2022. Logistic regression was used to calculate the odds ratios (ORs) for intensive care unit treatment-or ventilator use-related risk factors. Results Among 650,317 patients (mean age: 52.1 ± 20.9 years; male individuals: 324,127; female individuals: 326,190), factors that significantly increased the severe disease risk (OR [95% confidence interval]) included age > 65 years (1.31 [1.27-1.36]), hypertension (1.34 [1.28-1.41]), cardiovascular disease (1.74 [1.67-1.81]), and use of beta-blockers (2.09 [2.00-2.17]), calcium blockers (1.97 [1.89-2.06]), angiotensin-converting enzyme inhibitors (1.41 [1.33-1.49]), low-dose aspirin (1 .38 [1.32-1.45]), and insulin (7.14 [6.87-7.43]). Conversely, factors that reduced the severe disease risk included female sex and the use of sulfonylureas, dipeptidyl peptidase 4 inhibitors, glucagon-like peptide-1 receptor agonists, and alpha-glucosidase inhibitors. Conclusions Patients using cardiovascular medications faced a higher risk, whereas those receiving diabetes treatment had a lower risk. Appropriate pharmacotherapy and risk factor identification can aid in the prevention of severe COVID-19.
Supplementary Information The online version contains supplementary material available at https:// doi . org/ 10. 1186/ s12982-024-00225-7. Declarations Ethics approval and consent to participate This study was approved by the Ethical Committee of Kitasato University Medical Center (No. 2022028). The ethics committee confirmed that all methods were performed in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan and relevant regulations.
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' 'https://doi.org/10.1016/j.cmet.2020.04.021.', 'journal-title': 'Cell Metab'}, { 'key': '225_CR28', 'doi-asserted-by': 'publisher', 'first-page': '2030', 'DOI': '10.3390/jcm9072030', 'volume': '9', 'author': 'B Fernandez-Fernandez', 'year': '2020', 'unstructured': 'Fernandez-Fernandez B, D’Marco L, Górriz JL, Jacobs-Cachá C, Kanbay M, ' 'Luis-Lima S, et al. Exploring sodium glucose co-transporter-2 (SGLT2) ' 'inhibitors for organ protection in COVID-19. J Clin Med. 2020;9:2030. ' 'https://doi.org/10.3390/jcm9072030.', 'journal-title': 'J Clin Med'}, { 'key': '225_CR29', 'doi-asserted-by': 'publisher', 'first-page': '843', 'DOI': '10.1016/s0140-6736(21)01744-x', 'volume': '398', 'author': 'L-M Yu', 'year': '2021', 'unstructured': 'Yu L-M, Bafadhel M, Dorward J, Hayward G, Saville BR, Gbinigie O, et al. ' 'Inhaled budesonide for COVID-19 in people at high risk of complications ' 'in the community in the UK (PRINCIPLE): a randomised, controlled, ' 'open-label, adaptive platform trial. Lancet. 2021;398:843–55. ' 'https://doi.org/10.1016/s0140-6736(21)01744-x.', 'journal-title': 'Lancet'}, { 'key': '225_CR30', 'doi-asserted-by': 'publisher', 'first-page': '1065', 'DOI': '10.1016/s2213-2600(20)30447-1', 'volume': '8', 'author': 'D Singh', 'year': '2020', 'unstructured': 'Singh D, Halpin DMG. Inhaled corticosteroids and COVID-19-related ' 'mortality: confounding or clarifying? Lancet Respir Med. 2020;8:1065–6. ' 'https://doi.org/10.1016/s2213-2600(20)30447-1.', 'journal-title': 'Lancet Respir Med'}, { 'key': '225_CR31', 'doi-asserted-by': 'publisher', 'first-page': 'e0260451', 'DOI': '10.1371/journal.pone.0260451', 'volume': '16', 'author': 'M Hirayama', 'year': '2021', 'unstructured': 'Hirayama M, Nishiwaki H, Hamaguchi T, Ito M, Ueyama J, Maeda T, et al. ' 'Intestinal Collinsella may mitigate infection and exacerbation of ' 'COVID-19 by producing ursodeoxycholate. PLoS ONE. 2021;16:e0260451. ' 'https://doi.org/10.1371/journal.pone.0260451.', 'journal-title': 'PLoS ONE'}, { 'key': '225_CR32', 'doi-asserted-by': 'publisher', 'first-page': '35', 'DOI': '10.1265/ehpm.23-00061', 'volume': '28', 'author': 'K Tomioka', 'year': '2023', 'unstructured': 'Tomioka K, Uno K, Yamada M. Association between vaccination status and ' 'severe health consequences among community-dwelling COVID-19 patients ' 'during Omicron BA.1/BA.2 and BA.5-predominant periods in Japan. Environ ' 'Health Prev Med. 2023;28:35–35. https://doi.org/10.1265/ehpm.23-00061.', 'journal-title': 'Environ Health Prev Med'}, { 'key': '225_CR33', 'doi-asserted-by': 'publisher', 'first-page': '523', 'DOI': '10.2188/jea.je20200138', 'volume': '31', 'author': 'T Ikeda', 'year': '2021', 'unstructured': 'Ikeda T, Cable N, Saito M, Koyama S, Tsuji T, Noguchi T, et al. ' 'Association between social isolation and smoking in Japan and England. J ' 'Epidemiol. 2021;31:523–9. https://doi.org/10.2188/jea.je20200138.', 'journal-title': 'J Epidemiol'}, { 'key': '225_CR34', 'doi-asserted-by': 'publisher', 'first-page': '57040', 'DOI': '10.1007/s11356-022-21461-x', 'volume': '29', 'author': 'P Mal', 'year': '2022', 'unstructured': 'Mal P, Mukherjee T, Upadhyay AK, Mohanty S, Pattnaik AK. Connecting the ' 'dots between inflammatory cascades of obesity and COVID-19 in light of ' 'mortal consequences—a review. Environ Sci Pollut Res Int. ' '2022;29:57040–53. https://doi.org/10.1007/s11356-022-21461-x.', 'journal-title': 'Environ Sci Pollut Res Int'}, { 'key': '225_CR35', 'doi-asserted-by': 'publisher', 'unstructured': 'Kazemi SN, Hajikhani B, Didar H, Hosseini SS, Haddadi S, Khalili F, et ' 'al. COVID-19 and cause of pregnancy loss during the pandemic: a ' 'systematic review. PLoS ONE. 2021;1694. ' 'https://doi.org/10.1371/journal.pone.0255994.', 'DOI': '10.1371/journal.pone.0255994'}], 'container-title': 'Discover Public Health', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1186/s12982-024-00225-7.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1186/s12982-024-00225-7/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1186/s12982-024-00225-7.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2024, 9, 27]], 'date-time': '2024-09-27T12:02:40Z', 'timestamp': 1727438560000}, 'score': 1, 'resource': { 'primary': { 'URL': 'https://ete-online.biomedcentral.com/articles/10.1186/s12982-024-00225-7'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2024, 9, 27]]}, 'references-count': 35, 'journal-issue': {'issue': '1', 'published-online': {'date-parts': [[2024, 12]]}}, 'alternative-id': ['225'], 'URL': 'http://dx.doi.org/10.1186/s12982-024-00225-7', 'relation': {}, 'ISSN': ['3005-0774'], 'subject': [], 'container-title-short': 'Discov Public Health', 'published': {'date-parts': [[2024, 9, 27]]}, 'assertion': [ { 'value': '22 February 2024', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '13 September 2024', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '27 September 2024', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, {'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Declarations'}}, { 'value': 'This study was approved by the Ethical Committee of Kitasato University Medical ' 'Center (No. 2022028). The ethics committee confirmed that all methods were ' 'performed in accordance with the Ethical Guidelines for Medical and Health ' 'Research Involving Human Subjects in Japan and relevant regulations.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { 'value': 'This study utilized anonymized data from a retrospective analysis, and the need ' 'for informed consent from the subjects was waived by the Kitasato University ' 'Hospital Ethics Committee.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent to participate'}}, { 'value': 'Not applicable.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent to publish'}}, { 'value': 'The authors declare no competing interests.', 'order': 5, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '112'}
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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