학술논문
The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial
Document Type
Report
Author
Baldia, Philipp Heinrich; Wernly, Bernhard; Flaatten, Hans; Fjalner, Jesper; Artigas, Antonio; Pinto, Bernardo Bollen; Schefold, Joerg C.; Kelm, Malte; Beil, Michael; Bruno, Raphael Romano; Binnebössel, Stephan; Wolff, Georg; Erkens, Ralf; Sigal, Sviri; van Heerden, Peter Vernon; Szczeklik, Wojciech; Elhadi, Muhammed; Joannidis, Michael; Oeyen, Sandra; Marsh, Brian; Andersen, Finn H.; Moreno, Rui; Leaver, Susannah; De Lange, Dylan W.; Guidet, Bertrand; Jung, Christian; Eller, Philipp; Mesotten, Dieter; Reper, Pascal; Swinnen, Walter; Serck, Nicolas; DEWAELE, ELISABETH; Brix, Helene; Brushoej, Jens; Kumar, Pritpal; Nedergaard, Helene Korvenius; Balleby, Ida Riise; Bundesen, Camilla; Hansen, Maria Aagaard; Uhrenholt, Stine; Bundgaard, Helle; Innes, Richard; Gooch, James; Cagova, Lenka; Potter, Elizabeth; Reay, Michael; Davey, Miriam; Abusayed, Mohammed Abdelshafy; Humphreys, Sally; Galbois, Arnaud; Charron, Cyril; Berlemont, Caroline Hauw; Besch, Guillaume; Rigaud, Jean-Philippe; Maizel, Julien; Djibré, Michel; Burtin, Philippe; Garcon, Pierre; Nseir, Saad; Valette, Xavier; Alexandru, Nica; Marin, Nathalie; Vaissiere, Marie; PLANTEFEVE, Gaëtan; Vanderlinden, Thierry; Jurcisin, Igor; Megarbane, Buno; Chousterman, Benjamin Glenn; Dépret, François; Garnier, Marc; Besset, Sebastien; Oziel, Johanna; Ferre, Alexis; Dauger, Stéphane; Dumas, Guillaume; Goncalves, Bruno; Vettoretti, Lucie; Thevenin, Didier; Schaller, Stefan; Kurt, Muhammed; Faltlhauser, Andreas; Milovanovic, Milena; Lutz, Matthias; Shala, Gonxhe; Haake, Hendrik; Randerath, Winfried; Kunstein, Anselm; Meybohm, Patrick; Steiner, Stephan; Barth, Eberhard; Poerner, Tudor; Simon, Philipp; Lorenz, Marco; Dindane, Zouhir; Kuhn, Karl Friedrich; Welte, Martin; Voigt, Ingo; Kabitz, Hans-Joachim; Wollborn, Jakob; Goebel, Ulrich; Stoll, Sandra Emily; Kindgen-Milles, Detlef; Dubler, Simon; Fuest, Kristina; Schuster, Michael; Papadogoulas, Antonios; Mulita, Francesk; Rovina, Nikoletta; Aidoni, Zoi; CHRISANTHOPOULOU, EVANGELIA; KONDILI, EUMORFIA; Andrianopoulos, Ioannis; Groenendijk, Martijn; Evers, Mirjam; van Lelyveld-Haas, Lenneke; Meynaar, Iwan; Cornet, Alexander Daniel; Zegers, Marieke; Dieperink, Willem; de Lange, Dylan; Dormans, Tom; Hahn, Michael; Sjabae, Britt; Strietzel, Hans Frank; Olasveengen, Theresa; Romundstad, Luis; Kluzik, Anna; Zatorski, PaweÅ; Drygalski, Tomasz; Klimkiewicz, Jakub; Solek-pastuszka, Joanna; Onichimowski, Dariusz; Czuczwar, Miroslaw; Gawda, Ryszard; Stefaniak, Jan; Stefanska-Wronka, Karina; Zabul, Ewa; Oliveira, Ana Isabel Pinho; Assis, Rui; de Lurdes Campos Santos, Maria; Santos, Henrique; Cardoso, Filipe Sousa; Gordinho, André; Banzo, MJosé Arche; Zalba-Etayo, Begoéa; CUBERO, PATRICIA JIMENO; Priego, Jesús; Gomà, Gemma; Tomasa-Irriguible, Teresa Maria; Sancho, Susana; Ferreira, Aida Fernández; Vázquez, Eric Mayor; Mira, Ãngela Prado; Ibarz, Mercedes; Iglesias, David; Arias-Rivera, Susana; Frutos-Vivar, Fernando; Lopez-Cuenca, Sonia; Aldecoa, Cesar; Perez-Torres, David; Canas-Perez, Isabel; Tamayo-Lomas, Luis; Diaz-Rodriguez, Cristina; de Gopegui, Pablo Ruiz; Ben-Hamouda, Nawfel; Roberti, Andrea; Fleury, Yvan; Abidi, Nour; Dullenkopf, Alexander; Pugh, Richard; Smuts, Sara
Source
BMC Geriatrics. December 27, 2022, Vol. 22 Issue 1
Subject
Language
English
ISSN
1471-2318
Abstract
Author(s): Philipp Heinrich Baldia[sup.1] , Bernhard Wernly[sup.2] , Hans Flaatten[sup.3] , Jesper Fjalner[sup.4] , Antonio Artigas[sup.5] , Bernardo Bollen Pinto[sup.6] , Joerg C. Schefold[sup.7] , Malte Kelm[sup.1] , Michael Beil[sup.8] [...]
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 [greater than or equal to] 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. Keywords: COVID-19, Frailty, ICU, Paracetamol, Analgesics
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 [greater than or equal to] 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. Keywords: COVID-19, Frailty, ICU, Paracetamol, Analgesics