Introduction Colchicine may inhibit inflammasome signaling and reduce proinflammatory cytokines, a purported mechanism of COVID-19 pneumonia. The aim of this systematic review and meta-analysis is to report on the state of the current literature on the use of colchicine in COVID-19 and to investigate the reported clinical outcomes in COVID-19 patients by colchicine usage. Methods The literature was searched from January 2019 through January 28, 2021. References were screened to identify studies that reported the effect of colchicine usage on COVID-19 outcomes including mortality, intensive care unit (ICU) admissions, or mechanical ventilation. Studies were meta-analyzed for mortality by the subgroup of trial design (RCT vs observational) and ICU status. Studies reporting an risk ratio (RR), odds ratio (OR) and hazard ratio (HR) were analyzed separately. Results Eight studies, reporting on 16,248 patients, were included in this review. The Recovery trial reported equivalent mortality between colchicine and non-colchicine users. Across the other studies, patients who received colchicine had a lower risk of mortality—HR of 0.25 (95% CI: 0.09, 0.66) and OR of 0.22 (95% CI: 0.09, 0.57). There was no statistical difference in risk of ICU admissions between patients with COVID-19 who received colchicine and those who did not–OR of 0.26 (95% CI: 0.06, 1.09). Conclusion Colchicine may reduce the risk of mortality in individuals with COVID-19. Further prospective investigation may further determine the efficacy of colchicine as treatment in COVID-19 patients in various care settings of the disease, including post-hospitalization and long-term care.
Introduction: Colchicine may inhibit inflammasome signaling and reduce proinflammatory cytokines, a purported mechanism of COVID-19 pneumonia. The aim of this systematic review and meta-analysis is to report on the state of the current literature on the use of colchicine in COVID-19 and to investigate the reported clinical outcomes in COVID-19 patients by colchicine usage. Methods: The literature was searched from January 2019 through January 28, 2021. References were screened to identify studies that reported the effect of colchicine usage on COVID-19 outcomes including mortality, intensive care unit (ICU) admissions, or mechanical ventilation. Studies were meta-analyzed for mortality by the subgroup of trial design (RCT vs observational) and ICU status. Studies reporting an odds ratio (OR) and hazard ratio (HR) were analyzed separately. Results: Six studies, reporting on 5,033 patients, were included in this review. Across the six studies, COVID-19 patients who had colchicine had a lower risk of mortality - HR of 0.25 (95% CI: 0.09, 0.66) and OR of 0.36 (95% CI: 0.17, 0.76). Among the three observational studies, COVID-19 patients who received colchicine had a lower risk of mortality - HR of 0.25 (95% CI: 0.09, 0.66) and OR of 0.21 (95% CI: 0.06, 0.71). Among three randomized controlled trials, the summary point estimate suggests a direction toward benefit in mortality that is not statistically significant among patients receiving colchicine versus placebo - OR of 0.49 (95% CI: 0.20, 1.24). Conclusion: Colchicine may reduce the risk of mortality in individuals with COVID-19. Further prospective investigation is warranted to determine the efficacy of colchicine as treatment in COVID-19 patients in various care settings of the disease.
Introduction Famotidine is a competitive histamine H2-receptor antagonist most commonly used for gastric acid suppression but thought to have potential efficacy in treating patients with Coronavirus disease 2019 (COVID-19). The aims of this systematic review and meta-analysis are to summarize the current literature and report clinical outcomes on the use of famotidine for treatment of hospitalized patients with COVID-19. Methods Five databases were searched through February 12, 2021 to identify observational studies that reported on associations of famotidine use with outcomes in COVID-19. Meta-analysis was conducted for composite primary clinical outcome (e.g. rate of death, intubation, or intensive care unit admissions) and death separately, where either aggregate odds ratio (OR) or hazard ratio (HR) was calculated. Results Four studies, reporting on 46,435 total patients and 3,110 patients treated with famotidine, were included in this meta-analysis. There was no significant association between famotidine use and composite outcomes in patients with COVID-19: HR 0.63 (95% CI: 0.35, 1.16). Across the three studies that reported mortality separated from other endpoints, there was no association between famotidine use during hospitalization and risk of death—HR 0.67 (95% CI: 0.26, 1.73) and OR 0.79 (95% CI: 0.19, 3.34). Heterogeneity ranged from 83.69% to 88.07%. Conclusion Based on the existing observational studies, famotidine use is not associated with a reduced risk of mortality or combined outcome of mortality, intubation, and/or intensive care services in hospitalized individuals with COVID-19, though heterogeneity was high, and point estimates suggested a possible protective effect for the composite outcome that may not have been observed due to lack of power. Further randomized controlled trials (RCTs) may help determine the efficacy and safety of famotidine as a treatment for COVID-19 patients in various care settings of the disease.
Background: Heart failure (HF) is highly prevalent, whereas malnutrition is generally associated with poorer hospital outcomes, and it is not uncommon in patients with HF. Prior studies of the effect of malnutrition on HF outcomes are limited in size and quality. This study aims to elucidate the association between malnutrition and hospital length of stay (LOS), mortality, and discharge destination in patients with HF.Methods: This is a retrospective review of medical records for inpatients admitted with a primary diagnosis of HF in 2018. Patients with HF and severe proteincalorie malnutrition were compared with those without malnutrition. A twosided t-test was conducted between patients who have HF with and without malnutrition on hospital outcomes. Multivariate logistic regression was developed to identify potential predictors of malnutrition. A propensity score was calculated for each patient and matched cases (malnutrition with nonmalnutrition) to balance covariates and reduce bias. Results: For N = 7079, the median age was 75 years, with 15.79% having severe malnutrition. Overall mortality was 5.57% (394 deceased) . There were significant associations between malnutrition and both mortality (relative risk, 2.22; P < 0.001) and LOS (10 vs 5 days, P < 0.001) in patients with HF. Significantly fewer patients with malnutrition were discharged home (odds ratio, 0.41; P < 0.001). Conclusion: Patients with HF and malnutrition have higher risk for mortality, increased LOS in the hospital, and decreased chance of being discharged home. Continued study of this population is required to better predict which patients with malnutrition will respond to nutrition interventions.
Introduction: Famotidine is a competitive histamine H2-receptor antagonist most commonly used for gastric acid suppression but thought to have potential efficacy in treating patients with COVID-19. The aims of this systematic review and meta-analysis are to summarize the current literature and report clinical outcomes on the use of famotidine for treatment of hospitalized patients with COVID-19. Methods: Five databases were searched through February 12, 2021 to identify observational studies that reported on associations of famotidine use with outcomes in COVID-19. Meta-analysis was conducted for composite primary clinical outcome (e.g. rate of death, intubation, or intensive care unit admissions) and death separately, where either aggregate odds ratio (OR) or hazard ratio (HR) was calculated. Results: Four studies, reporting on 46,435 total patients and 3,110 patients treated with famotidine, were included in this meta-analysis. There was no significant association between famotidine use and composite outcomes in patients with COVID-19: HR 0.63 (95% CI: 0.35, 1.16). Across the three studies that reported mortality separated from other endpoints, there was no association between famotidine use during hospitalization and risk of death - HR 0.67 (95% CI: 0.26, 1.73) and OR 0.79 (95% CI: 0.19, 3.34). Heterogeneity ranged from 83.69% to 88.07%. Conclusion: Based on the existing observational studies, famotidine use is not associated with a reduced risk of mortality or combined outcome of mortality, intubation, and/or intensive care services in hospitalized individuals with COVID-19, though heterogeneity was high, and point estimates suggested a possible protective effect for the composite outcome that may not have been observed due to lack of power. Further RCTs may help determine the efficacy and safety of famotidine as a treatment for COVID-19 patients in various care settings of the disease
Objectives Refeeding syndrome is characterized by rapid and severe hypokalemia, hypophosphatemia, hypomagnesemia, and/or Wernicke's encephalitis occurring subsequent to reintroduction of calories, usually after prolonged starvation. These electrolyte decrements may lead to complications such as organ failure and death, which should be prevented with effective monitoring and supplementation. However, there is poor agreement on the definition of refeeding syndrome, limited understanding of its risk factors, and, unsurprisingly, poorly described patient outcomes. This pilot evaluation is part of an ongoing study seeking to better define the syndrome and elucidate predictive factors enabling preventive and treatment strategies and develop clear guidelines. Methods A retrospective case-control study was performed at New York Presbyterian Hospital with inpatients admitted during 2015–2017. Patients with low levels of potassium, phosphorus, and/or magnesium within 3 days of the introduction of any oral, enteral, or parenteral source of calories were included. Type of diet and supplementation, demographics, nutritional history including weight change and intake, as well as comorbid conditions and medications, particularly those likely to cause alterations in electrolyte balance, as well as outcomes such as length of stay (LOS) and mortality were also noted for each admission. Results Nearly 48,000 unique qualifying admissions were identified and verified with random quality checks. Preliminary results demonstrate a significant positive relationship between the degree of initial low magnesium or potassium level, but not with phosphorus, and length of stay. Magnesium values in the lowest third of low values had mean LOS 7.1, vs 6.3 days in those with highest levels (OR 1.18; 1.09–1.29). Low potassium values, by lowest to highest quartile, were associated with mean LOS of 7.0, 6.2, 6.1 days, vs. 4.7 days in those with the highest levels (OR 1.57 (1.47–1.68); 1.37 (1.28–1.45); 1.29 (1.21–1.37)). Conclusions Despite identification in the literature of phosphorus as the prime component of refeeding syndrome, low levels had no impact on LOS, unlike magnesium and potassium. Next steps include comparison against a matched control group to identify factors that may increase refeeding syndrome risk. Funding Sources None.
Objectives The association between inflammation, malnutrition, and cancer is not well understood. The aim of this study was to examine the association between inflammatory-type cancer and diagnosed malnutrition, albumin level, and age in patients with cancer. Methods Malnutrition and cancer diagnoses were obtained using data from hospital medical records in patients admitted for cancer between Oct. 2017 and Dec. 2018. Demographics, as well as the first and lowest albumin levels were also obtained. A simple t-test is processed between age and malnutrition status. Also a chi-square test of independence was performed to examine the relation between malnutrition and hypoalbuminemia status. Logistic regression was conducted between malnutrition status, sarcoma cancer, age, and hypoalbuminemia. Results The study included 4034 patients (2084 males, 1949 females). Approximately 4% of the patients were diagnosed with malnutrition. Logistic regression on malnutrition status, sarcoma, age, and hypoalbuminemia showed a significant association on global test (3, 2433, P-value = 0.013). Hypoalbuminemia (< 3.9 g/dL lower-limit) was significantly associated with malnutrition (X2 1, 2433 P-value = 0.0156). Sarcoma diagnosis was not significantly associated with malnutrition (X2 1, 2433 P-value = 0.267). Age is not significantly related to malnutrition status (X2 1, 2433 p-value = 0.449). A t-test was also performed malnutrition vs no malnutrition on age, resulting in a marginally significant association for malnutrition group (M = 65.33, SD = 15.50) vs no malnutrition group (M = 67.32, SD = 17.55) (t(1) = 3.7212, P = 0.0537). Conclusions Sarcoma is not significantly associated with an increased risk of malnutrition. Cancer patients with hypoalbuminemia have a higher risk for malnutrition compared to the patients with normal albumin level. Additionally, age may be a predictor for cancer patients’ risk of in-hospital malnutrition. Funding Sources None.
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