Relationship between fluoroquinolones and the risk of aortic diseases: a meta-analysis of observational studies

Abstract

Background Our aim was to find possible risk associated between fluoroquinolones and aortic diseases.Methods PubMed, Embase and the Web of Science were searched from inception to July 6, 2019 to identify observational studies that evaluated the risk for aortic diseases associated with users of fluoroquinolones compared with non-users or users of other antibiotics. Primary outcome was the first occurrence of aortic diseases. We used Newcastle Ottawa Scale to assess quality among cohort and case-control studies and the GRADE approach was used for rating strength of evidence and used inverse variance method random-effect model to estimate odds risks (ORs) with 95% CIs and statistical heterogeneity were assessed by the I 2 statistic.Results Five observational studies that enrolled 2,829,385 patients were reported the relationship between fluoroquinolones and the risk for aortic diseases. Compared with non-users or users of other antibiotics, current fluoroquinolone use had association with a significantly increased risk of occurrence of aortic diseases (adjusted OR, 2.15; 95% CI, 1.66-2.64; P=.000). The risk of past fluoroquinolone use remained high in aortic dissection (adjusted OR, 1.98; 95% CI, 0.97-2.99; P=.000) and aortic aneurysm (adjusted OR, 1.77; 95% CI, 0.98-2.57; P=.000). The quality of evidence was moderate and the Number Need to Treat to Harm (NNTH) for aortic diseases among elderly patients above the age of 50 were current users of fluoroquinolones was estimated to be 1245.Conclusions The current fluoroquinolones use within elderly patients significantly increased the risk for the first occurrence of aortic diseases. Clinicians need to pay attention to these severe adverse events when considering fluoroquinolone use.