The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial.
Analgesics
COVID-19
Frailty
ICU
Paracetamol
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
27 12 2022
27 12 2022
Historique:
received:
14
01
2022
accepted:
19
12
2022
entrez:
27
12
2022
pubmed:
28
12
2022
medline:
30
12
2022
Statut:
epublish
Résumé
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. This prospective international observation study (The COVIP study) recruited ICU patients ≥ 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. 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. 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. This prospective international multicentre study was registered on ClinicalTrials.gov with the identifier "NCT04321265" on March 25, 2020.
Sections du résumé
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 ≥ 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.
Identifiants
pubmed: 36575394
doi: 10.1186/s12877-022-03709-w
pii: 10.1186/s12877-022-03709-w
pmc: PMC9794407
doi:
Substances chimiques
Acetaminophen
362O9ITL9D
Banques de données
ClinicalTrials.gov
['NCT04321265']
Types de publication
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1000Subventions
Organisme : Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
ID : 2020-21
Organisme : Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
ID : 2018-32
Investigateurs
Philipp Eller
(P)
Michael Joannidis
(M)
Dieter Mesotten
(D)
Pascal Reper
(P)
Walter Swinnen
(W)
Nicolas Serck
(N)
Elisabeth Dewaele
(E)
Helene Brix
(H)
Jens Brushoej
(J)
Pritpal Kumar
(P)
Helene Korvenius Nedergaard
(HK)
Ida Riise Balleby
(IR)
Camilla Bundesen
(C)
Maria Aagaard Hansen
(MA)
Stine Uhrenholt
(S)
Helle Bundgaard
(H)
Richard Innes
(R)
James Gooch
(J)
Lenka Cagova
(L)
Elizabeth Potter
(E)
Michael Reay
(M)
Miriam Davey
(M)
Mohammed Abdelshafy Abusayed
(MA)
Sally Humphreys
(S)
Arnaud Galbois
(A)
Cyril Charron
(C)
Caroline Hauw Berlemont
(CH)
Guillaume Besch
(G)
Jean-Philippe Rigaud
(JP)
Julien Maizel
(J)
Michel Djibré
(M)
Philippe Burtin
(P)
Pierre Garcon
(P)
Saad Nseir
(S)
Xavier Valette
(X)
Nica Alexandru
(N)
Nathalie Marin
(N)
Marie Vaissiere
(M)
Gaëtan Plantefeve
(G)
Thierry Vanderlinden
(T)
Igor Jurcisin
(I)
Buno Megarbane
(B)
Benjamin Glenn Chousterman
(BG)
François Dépret
(F)
Marc Garnier
(M)
Sebastien Besset
(S)
Johanna Oziel
(J)
Alexis Ferre
(A)
Stéphane Dauger
(S)
Guillaume Dumas
(G)
Bruno Goncalves
(B)
Lucie Vettoretti
(L)
Didier Thevenin
(D)
Stefan Schaller
(S)
Stefan Schaller
(S)
Muhammed Kurt
(M)
Andreas Faltlhauser
(A)
Stefan Schaller
(S)
Milena Milovanovic
(M)
Matthias Lutz
(M)
Gonxhe Shala
(G)
Hendrik Haake
(H)
Winfried Randerath
(W)
Anselm Kunstein
(A)
Patrick Meybohm
(P)
Stefan Schaller
(S)
Stephan Steiner
(S)
Eberhard Barth
(E)
Tudor Poerner
(T)
Philipp Simon
(P)
Marco Lorenz
(M)
Zouhir Dindane
(Z)
Karl Friedrich Kuhn
(KF)
Martin Welte
(M)
Ingo Voigt
(I)
Hans-Joachim Kabitz
(HJ)
Jakob Wollborn
(J)
Ulrich Goebel
(U)
Sandra Emily Stoll
(SE)
Detlef Kindgen-Milles
(D)
Simon Dubler
(S)
Christian Jung
(C)
Kristina Fuest
(K)
Michael Schuster
(M)
Antonios Papadogoulas
(A)
Francesk Mulita
(F)
Nikoletta Rovina
(N)
Zoi Aidoni
(Z)
Evangelia Chrisanthopoulou
(E)
Eumorfia Kondili
(E)
Ioannis Andrianopoulos
(I)
Martijn Groenendijk
(M)
Mirjam Evers
(M)
Mirjam Evers
(M)
Lenneke van Lelyveld-Haas
(L)
Iwan Meynaar
(I)
Alexander Daniel Cornet
(AD)
Marieke Zegers
(M)
Willem Dieperink
(W)
Dylan de Lange
(D)
Tom Dormans
(T)
Michael Hahn
(M)
Britt Sjøbøe
(B)
Hans Frank Strietzel
(HF)
Theresa Olasveengen
(T)
Luis Romundstad
(L)
Anna Kluzik
(A)
Paweł Zatorski
(P)
Tomasz Drygalski
(T)
Jakub Klimkiewicz
(J)
Joanna Solek-Pastuszka
(J)
Dariusz Onichimowski
(D)
Miroslaw Czuczwar
(M)
Ryszard Gawda
(R)
Jan Stefaniak
(J)
Karina Stefanska-Wronka
(K)
Ewa Zabul
(E)
Ana Isabel Pinho Oliveira
(AIP)
Rui Assis
(R)
Maria de Lurdes Campos Santos
(M)
Henrique Santos
(H)
Filipe Sousa Cardoso
(FS)
André Gordinho
(A)
MJosé Arche Banzo
(MA)
Begoña Zalba-Etayo
(B)
Patricia Jimeno Cubero
(PJ)
Jesús Priego
(J)
Gemma Gomà
(G)
Teresa Maria Tomasa-Irriguible
(TM)
Susana Sancho
(S)
Aida Fernández Ferreira
(AF)
Eric Mayor Vázquez
(EM)
Ángela Prado Mira
(ÁP)
Mercedes Ibarz
(M)
David Iglesias
(D)
Susana Arias-Rivera
(S)
Fernando Frutos-Vivar
(F)
Sonia Lopez-Cuenca
(S)
Cesar Aldecoa
(C)
David Perez-Torres
(D)
Isabel Canas-Perez
(I)
Luis Tamayo-Lomas
(L)
Cristina Diaz-Rodriguez
(C)
Pablo Ruiz de Gopegui
(PR)
Nawfel Ben-Hamouda
(N)
Andrea Roberti
(A)
Yvan Fleury
(Y)
Nour Abidi
(N)
Alexander Dullenkopf
(A)
Richard Pugh
(R)
Sara Smuts
(S)
Informations de copyright
© 2022. The Author(s).
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