The swedish covid‐19 intensive care cohort: Risk factors of ICU admission and ICU mortality

Abstract

Background Several studies have recently addressed factors associated with severe Coronavirus disease 2019 (COVID‐19); however, some medications and comorbidities have yet to be evaluated in a large matched cohort. We therefore explored the role of relevant comorbidities and medications in relation to the risk of intensive care unit (ICU) admission and mortality. Methods All ICU COVID‐19 patients in Sweden until 27 May 2020 were matched to population controls on age and gender to assess the risk of ICU admission. Cases were identified, comorbidities and medications were retrieved from high‐quality registries. Three conditional logistic regression models were used for risk of ICU admission and three Cox proportional hazards models for risk of ICU mortality, one with comorbidities, one with medications and finally with both models combined, respectively. Results We included 1981 patients and 7924 controls. Hypertension, type 2 diabetes mellitus, chronic renal failure, asthma, obesity, being a solid organ transplant recipient and immunosuppressant medications were independent risk factors of ICU admission and oral anticoagulants were protective. Stroke, asthma, chronic obstructive pulmonary disease and treatment with renin‐angiotensin‐aldosterone inhibitors (RAASi) were independent risk factors of ICU mortality in the pre‐specified primary analyses; treatment with statins was protective. However, after adjusting for the use of continuous renal replacement therapy, RAASi were no longer an independent risk factor. Conclusion In our cohort oral anticoagulants were protective of ICU admission and statins was protective of ICU death. Several comorbidities and ongoing RAASi treatment were independent risk factors of ICU admission and ICU mortality.

The Association Between the Use of Statins and Clinical Outcomes in Patients with COVID-19: A Systematic Review and Meta-analysis

“…All the included studies [ 11 – 45 ] are observational studies, reported as cohort/case–control studies or database reviews. All except seven studies [ 18 , 26 , 29 , 34 , 35 , 38 , 39 ] were based directly on the hospital (or nursing home) medical records, and 12 of the included studies [ 13 , 20 , 22 , 23 , 25 , 31 , 33 , 36 , 41 – 44 ] are single-centered observational studies. These hospital- (or nursing home)-based studies [ 11 – 17 , 19 – 25 , 27 , 28 , 30 – 34 , 36 , 37 , 40 – 45 ] covered a moderate number of participants per study (median 840.0, interquartile range 286.5–1997.5).…”

“…These hospital- (or nursing home)-based studies [ 11 – 17 , 19 – 25 , 27 , 28 , 30 – 34 , 36 , 37 , 40 – 45 ] covered a moderate number of participants per study (median 840.0, interquartile range 286.5–1997.5). The remaining seven studies [ 18 , 26 , 29 , 34 , 35 , 38 , 39 ] analyzed data from the nation-level registries (retrospective database reviews), and included a range of 1868–64,781 participants. The regions where the included studies were performed span Asia (China [ n = 4] [ 11 , 12 , 27 , 42 ], Iran [ n = 1] [ 31 ], and Korea [ n = 1] [ 39 ]), Europe (Italy [ n = 4] [ 14 , 23 , 28 , 37 ], the United Kingdom [ n = 2] [ 25 , 30 ], Belgium [ n = 1] [ 15 ], France [ n = 1] [ 19 ], Spain [ n = 3] [ 24 , 35 , 40 ], Denmark [ n = 1] [ 26 ], Poland [ n = 1] [ 44 ], Sweden [ n = 1] [ 38 ], and Belgium [ n = 1] [ 32 ]), and North America (the United States of America [ n = 14] [ 13 , 16 – 18 , 20 – 22 , 29 , 33 , 34 , 36 , 41 , 43 , 45 ]).…”

“…The remaining seven studies [ 18 , 26 , 29 , 34 , 35 , 38 , 39 ] analyzed data from the nation-level registries (retrospective database reviews), and included a range of 1868–64,781 participants. The regions where the included studies were performed span Asia (China [ n = 4] [ 11 , 12 , 27 , 42 ], Iran [ n = 1] [ 31 ], and Korea [ n = 1] [ 39 ]), Europe (Italy [ n = 4] [ 14 , 23 , 28 , 37 ], the United Kingdom [ n = 2] [ 25 , 30 ], Belgium [ n = 1] [ 15 ], France [ n = 1] [ 19 ], Spain [ n = 3] [ 24 , 35 , 40 ], Denmark [ n = 1] [ 26 ], Poland [ n = 1] [ 44 ], Sweden [ n = 1] [ 38 ], and Belgium [ n = 1] [ 32 ]), and North America (the United States of America [ n = 14] [ 13 , 16 – 18 , 20 – 22 , 29 , 33 , 34 , 36 , 41 , 43 , 45 ]). Seven studies [ 15 , 19 , 32 – 34 , 38 , 42 ] (could have) included both laboratory-confirmed and clinically or radiologically confirmed patients with COVID-19, while the remaining studies [ 11 – 14 , 16 – 18 , 20 – 31 , 33 – 37 , 39 – 41 ,…”

Mild COVID-19 manifestation in multiple risk factor patient on methotrexate, who had been treated with UVB phototherapy and had sufficient plasma 25-OH-vitamin D3 level

“…Almost immediately after the pandemic outbreak in China, greater vulnerability and higher incidence of severe clinical presentation and fatal outcome were observed in patients with particular preexisting conditions, especially in persons aged > 65 1,2 . Numerous studies have shown that the greatest risk of severe COVID-19 course/manifestation is posed by the presence of either diabetes mellitus, obesity, arterial hypertension or immunosuppression / immunodeficiency [3][4][5][6][7][8] . Severe COVID-19 manifestations include development of extensive bilateral pneumonia, ARDS and endothelial damage accompanied with accelerated thrombogenesis, which can all lead to the respiratory and multiorgan failure, being major clinical concern due to intensive care units overcrowding and high mortality rate 4,6 .…”

Pitavastatin: focus on safety and drug interactions

“…Появились данные наблюдательных исследований, рассматривающих влияние сопутствующей терапии на течение коронавирусной инфекции. Так, в шведском госпитальном регистре, включавшем всех пациентов, находившихся в отделениях интенсивной терапии, показано, что применение антикоагулянтов и статинов является независимым протективным фактором, а применение блокаторов ренин-ангиотензиновой системы существенно на прогноз пациентов не влияет [31]. Проведенный в конце 2020 г. метаанализ 13 наблюдательных исследований не подтвердил протективных эффектов статинов в отношении риска смерти от новой коронавирусной инфекции, однако данные многофакторного регрессионного анализа подтвердили версию об их возможном протективном действии [32].…”