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?:abstract
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Study Objectives: Concerns over the use of non-steroidal anti-inflammatory drugs (NSAIDs) for the management of fever and myalgia in COVID-19 patients were raised after four cases of critical illness in young, otherwise healthy patients who took NSAIDS were observed in France France’s health minister subsequently made a recommendation to use acetaminophen in lieu of ibuprofen However, the association between NSAID use and outcomes in COVID-19 illness has not been adequately studied The objective of this study is to determine whether an association exists between prior NSAID use and COVID-19 illness severity Methods: We performed a single-center retrospective cohort study of consecutive adult patients diagnosed in the emergency department (ED) with PCR confirmed SARS-Cov-2 infection NSAID use was ascertained based on a review of the medication list found in patients’ electronic medical records Our primary outcome was critical COVID-19 illness, defined as a composite of death, respiratory failure requiring intubation, and shock requiring vasopressors, occurring within 28 days of ED presentation We modeled the association between NSAID use and our primary outcome using logistic regression, and adjusting for hypertension, diabetes, asthma, chronic obstructive pulmonary disease (COPD), other chronic lung disease, obstructive sleep apnea, immunocompromised status, angiotensin converting enzyme inhibitor (ACE-I) or aldosterone receptor blocker (ARB) use, anticoagulation use, and immunosuppressant use Results: Among the 422 patients studied, 88 (21%) were on NSAIDS prior to acquiring COVID-19 and a total of 89 patients (21%) developed critical COVID-19 illness within 28 days of ED presentation Among those using NSAIDs, 18 (20%) developed critical illness Of the 11 predictor variables examined, hypertension (odds ratio = 1 04 (95% CI: 0 38 - 1 71)), diabetes (0 97 (95% CI: 0 42 - 1 52)), and chronic lung disease (1 20 (0 20 - 2 20)) were significantly associated with increased risk of critical COVID-19 illness (Table 1) NSAID use was not found to be an independent predictor of critical COVID-19 illness (odds ratio = 0 05 (95% CI;-0 57 - 0 73) Conclusion: To our knowledge, this is the first study of the association between NSAID use and critical COVID-19 illness Our results demonstrate that NSAID use does not significantly increase the risk of critical COVID-19 illness This study is limited by lack of prospective ascertainment of NSAID use Prospective evaluation of evaluate outcomes among COVID-19 patients with NSAID use is warranted [Formula presented]
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