This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of systemic corticosteroids in the treatment of patients with severe community-acquired pneumonia ...(sCAP).
A comprehensive search was conducted using the Medline, Embase, ClinicalTrials.gov, and Scopus databases for articles published until April 24, 2023. Only randomized controlled trials (RCTs) that assessed the clinical efficacy and safety of adjunctive corticosteroids for treating sCAP were included. The primary outcome was the 30-day all-cause mortality.
A total of severe RCTs involving 1689 patients were included in this study. Overall, the study group had a lower mortality rate at day 30 than the control group (risk ratio RR, 0.61; 95% CI 0.44 to 0.85; p < 0.01) with low heterogeneity (I
= 0%, p = 0.42). Compared to the control group, the study group had a lower risk of the requirement of mechanical ventilation (RR 0.57; 95% CI 0.45 to 0.73; p < 0.001), shorter length of intensive care unit (MD - 0.8; 95% CI - 1.4 to - 0.1; p = 0.02), and hospital stay (MD - 1.1; 95% CI - 2.0 to - 0.1; p = 0.04). Finally, no significant difference was observed between the study and the control groups in terms of gastrointestinal tract bleeding (RR 1.03; 95% CI 0.49 to 2.18; p = 0.93), healthcare-associated infection (RR 0.89; 95% CI 0.60 to 1.32; p = 0.56), and acute kidney injury (RR 0.68; 95% CI 0.21 to 2.26; p = 0.53).
In patients with sCAP, adjunctive corticosteroids can provide survival benefits and improve clinical outcomes without increasing adverse events. However, because the pooled evidence remains inconclusive, further studies are required.
The efficacy of molnupiravir in treating patients with coronavirus disease 2019 (COVID‐19) has been inconsistent across randomized controlled trials (RCTs). Thus, this meta‐analysis was conducted to ...clarify the literature. A literature search of electronic databases—PubMed, Embase, and Cochrane Library—was performed to identify relevant articles published up to December 31, 2022. Only RCTs that investigated the clinical efficacy and safety of molnupiravir for patients with COVID‐19 were included. The primary outcome was all‐cause mortality at 28–30 days. This pooled analysis of nine RCTs did not reveal a significant difference in all‐cause mortality between molnupiravir and control groups (risk ratio RR, 0.43; 95% confidence interval CI, 0.10–1.77) for overall patients. However, the risks of mortality and hospitalization were lower in the molnupiravir group than in the control group (mortality: RR, 0.28; 95% CI, 0.10–0.79; hospitalization: RR, 0.67; 95% CI, 0.45–0.99) among nonhospitalized patients. In addition, molnupiravir use was associated with a borderline higher virological eradication rate relative to the control (RR, 1.05; 95% CI, 1.00–1.11). Finally, no significant difference in adverse event risk was discovered between the groups (RR, 0.98; 95% CI, 0.89–1.08). The findings reveal the clinical benefits of molnupiravir for nonhospitalized patients with COVID‐19. However, molnupiravir may not improve the clinical outcomes of hospitalized patients. These findings support the recommended use of molnupiravir for treating nonhospitalized patients with COVID‐19 but not for hospitalized patients.
The retrospective cohort was conducted to assess the effect of nirmatrelvir‐ritonavir (NMV‐r) on the long‐term risk of neuropsychiatric sequela following COVID‐19. TriNetX research network was used ...to identify nonhospitalized adult patients who tested positive for severe acute respiratory syndrome coronavirus 2 infection or were diagnosed with COVID‐19 between March 1, 2020 and July 1, 2022. Further propensity score matching method was used to create two matched cohorts with and without receiving NMV‐r. The primary outcome was the incidence of neuropsychiatric sequela within a 90‐day to 1‐year period following a diagnosis of COVID‐19. After screening 119 494 527 electronic health records, two matched cohorts of each 27 194 patients were identified. During the follow‐up period, the NMV‐r group demonstrated a reduced risk of any neuropsychiatric sequelae compared to the control group (odds ratio OR, 0.634; 95% confidence interval CI, 0.604−0.667). In comparison with the control group, the patient treated with NMV‐r exhibited a markedly diminished risk of developing neurocognitive sequela (OR, 0.377; 95% CI, 0.325−0.439) and psychiatric sequela (OR, 0.629; 95% CI, 0.593−0.666). In addition, patients treated with NMV‐r had a significantly reduced risk of developing dementia (OR, 0.365; 95% CI, 0.255−0.522), depression (OR, 0.555; 95% CI, 0.503−0.612), insomnia (OR, 0.582; 95% CI, 0.508−0.668) and anxiety disorder (OR, 0.645 95% CI, 0.600−0.692). Moreover, the beneficial effect of NMV‐r on the neuropsychiatric sequelae was observed across further subgroup analyses. Among nonhospitalized COVID‐19 patients, who at risk of disease progression, the use of NMV‐r is associated with a reduction in the long‐term risk of neuropsychiatric sequela, including dementia, depression, insomnia and anxiety disorder. It may be necessary to re‐evaluate the use of NMV‐r, as a preventive measure to reduce the risk of severe acute disease and post‐acute adverse mental health outcomes.
The aim of this study was to investigate the clinical efficacy of a combination of nirmatrelvir and ritonavir (NMV‐r) for treating COVID‐19 in patients with diabetes mellitus (DM). This retrospective ...cohort study used the TriNetX research network to identify adult diabetic patients with COVID‐19 between January 1, 2020, and December 31, 2022. Propensity score matching was used to match patients who received NMV‐r (NMV‐r group) with those who did not receive NMV‐r (control group). The primary outcome was all‐cause hospitalization or death during the 30‐day follow‐up period. Two cohorts comprising 13 822 patients with balanced baseline characteristics were created using propensity score matching. During the follow‐up period, the NMV‐r group had a lower risk of all‐cause hospitalization or death than the control group (1.4% n = 193 vs. 3.1% n = 434; hazard ratio HR, 0.497; 95% confidence interval CI, 0.420–0.589). Compared with the control group, the NMV‐r group also had a lower risk of all‐cause hospitalization (HR, 0.606; 95% CI, 0.508–0.723) and all‐cause mortality (HR, 0.076; 95% CI, 0.033–0.175). This lower risk was consistently observed in almost all subgroup analyses, which examined sex (male: 0.520 0.401–0.675; female: 0.586 0.465–0.739), age (age 18–64 years: 0.767 0.601–0.980; ≥65 years: 0.394 0.308–0.505), level of HbA1c (<7.5%: 0.490 0.401–0.599; ≥7.5%: 0.655 0.441–0.972), unvaccinated (0.466 0.362–0.599), type 1 DM (0.453 0.286–0.718) and type 2 DM (0.430 0.361–0.511). NMV‐r can help reduce the risk of all‐cause hospitalization or death in nonhospitalized patients with DM and COVID‐19.
The long‐term risk of herpes zoster (HZ) after recovery from a SARS‐CoV‐2 infection is unclear. This retrospective cohort study assessed the risk of HZ in patients following a COVID‐19 diagnosis. ...This retrospective, propensity score‐matched cohort study was based on the multi‐institutional research network TriNetX. The risk of incident HZ in patients with COVID‐19 was compared with that of those not infected with SARS‐CoV‐2 during a 1‐year follow‐up period. Hazard ratios (HRs) and 95% confidence intervals (CIs) of HZ and its subtypes were calculated. This study identified 1 221 343 patients with and without COVID‐19 diagnoses with matched baseline characteristics. During the 1‐year follow‐up period, patients with COVID‐19 had a higher risk of HZ compared with those without COVID‐19 (HR: 1.59; 95% CI: 1.49–1.69). In addition, compared with the control group patients, those with COVID‐19 had a higher risk of HZ ophthalmicus (HR: 1.31; 95% CI: 1.01–1.71), disseminated zoster (HR: 2.80; 95% CI: 1.37–5.74), zoster with other complications (HR: 1.46; 95% CI: 1.18–1.79), and zoster without complications (HR: 1.66; 95% CI: 1.55–1.77). Kaplan–Meier curve analysis (log‐rank p < 0.05) results indicated that the risk of HZ remained significantly higher in patients with COVID‐19 compared with those without COVID‐19. Finally, the higher risk of HZ in the COVID‐19 cohort compared with that in the non‐COVID‐19 cohort remained consistent across subgroup analyses regardless of vaccine status, age, or sex. The risk of HZ within a 12‐month follow‐up period was significantly higher in patients who had recovered from COVID‐19 compared with that in the control group. This result highlights the importance of carefully monitoring HZ in this population and suggests the potential benefit of the HZ vaccine for patients with COVID‐19.
Several randomized controlled trials and real‐world cohort studies have demonstrated the efficacies of nirmatrelvir plus ritonavir (NMV‐r) and molnupiravir (MOV) in at‐risk patients with COVID‐19; ...however, the effectiveness of antisevere acute respiratory syndrome‐coronavirus 2 treatments on older patients (≥65 years) remains unclear. This retrospective cohort study aimed to assess the clinical effectiveness of the oral antiviral agents, MOV and NMV‐r, in older patients (≥65 years) infected with severe acute respiratory syndrome‐coronavirus 2. Nonhospitalized older patients with COVID‐19 between January 1, 2022, and December 31, 2022, were recruited from the TriNetX Research Network. Propensity score matching (PSM) was used to match patients who received either NMV‐r or MOV treatment with those who did not receive any oral antiviral agents. Hazard ratios (HRs) for composite all‐cause hospitalization or death during the 30‐day follow‐up period were calculated. PSM revealed two cohorts with 28 824 patients each having balanced baseline characteristics. The antiviral group was associated with significantly lower risk of the primary composite outcome of all‐cause hospitalization or death than the control group (241 vs. 801; HR, 0.307; 95% confidence interval (CI), 0.27–0.36) during the follow‐up period. For the secondary outcome, the antiviral group had a significantly lower risk of all‐cause hospitalization (288 vs. 725; HR, 0.322; 95% CI, 0.28–0.37) and mortality (16 vs. 94; HR, 0.176; 95% CI, 0.10–0.30) than the control group. Moreover, the reduced risk of all‐cause hospitalization or death remained consistent in patients receiving NMV‐r (HR, 0.279; 95% CI, 0.24–0.33) and MOV (HR, 0.279; 95% CI, 0.21–0.38). Our results revealed that NMV‐r and MOV decreased the all‐cause hospitalization and death rates among older patients with COVID‐19, supporting the use of antivirals in this vulnerable population.
To date, no studies have investigated the prevalence of post-COVID-19 conditions in patients with Intellectual and Developmental Disabilities (IDD). Addressing this research gap is crucial, as ...understanding post-COVID-19 conditions in IDD patients can improve care planning, and it is essential not to overlook this vulnerable population in COVID-19 studies. This study was aimed at investigating the prevalence of post-COVID-19 conditions in patients with IDD and compare their risk with that of the general population.
Using the TriNetX network, we identified patients with and without an IDD who had COVID-19. Subsequently, we compared the risk of developing any post-COVID-19 condition between these two groups, during the 90-180-day follow-up after SARS-CoV-2 infection.
During the follow-up, patients with an IDD exhibited a significantly higher prevalence of post-COVID-19 conditions compared to the general population (hazard ratio HR, 1.120; 95% confidence interval CI: 1.053-1.191). Specifically, COVID-19 survivors with IDD had a significantly increased risk of experiencing abnormal breathing (HR, 1.216; 95% CI: 1.077-1.373), abdominal symptoms (HR, 1.259; 95% CI: 1.128-1.406), fatigue (HR, 1.397; 95% CI: 1.216-1.606), anxiety/depression (HR, 1.157; 95% CI: 1.050-1.274), cognitive symptoms (HR, 1.828; 95% CI: 1.529-2.186), myalgia (HR, 1.325; 95% CI: 1.077-1.631), sleep disturbances (HR, 1.481; 95% CI: 1.148-1.910), and cough (HR, 1.315; 95% CI: 1.146-1.508) compared to the non-IDD group.
Patients with IDD might be associated with a higher risk of post-COVID-19 conditions following SARS-CoV-2 infection compared to the general population.
Few studies have directly compared the risk and magnitude of post-acute sequelae following COVID-19 and influenza, and most of these studies were conducted before emergence of the Omicron. This study ...investigated the prevalence of post-COVID conditions and the long-term risk of emergency department (ED) visits, hospitalizations, and deaths in patients with COVID-19 and compared their risk with that of patients with influenza.
A retrospective study based on the TriNetX databases, a global health research network. We identified patients with COVID-19 and influenza who required hospitalization between January 1, 2022, and January 1, 2023. We compared the risk of developing any post-COVID conditions between the two groups and also analyzed each post-COVID-19 condition and all-cause ED visits, hospitalizations, and deaths in both populations during the follow-up 90-180 days.
Before matching, 7,187 patients with COVID-19 were older (63.9 ± 16.7 vs. 55.4 ± 21.2) and were predominantly male (54.0% vs. 45.4%), and overweight/obese (16.1% vs. 11.2%) than 11,266 individuals with influenza. After propensity score matching, 6,614 patients were identified in each group, resulting in well-balanced baseline characteristics. During follow-up, the COVID-19 group had a higher incidence of any post-COVID-19 condition when compared with the influenza group (17.9% vs. 13.0%), with a hazard ratio (HR) of 1.398 (95% CI, 1.251-1.562). Compared to the influenza group, the COVID-19 group had a significantly higher incidence of abnormal breathing (HR, 1.506; 95% CI, 1.246-1.822), abdominal symptoms (HR, 1.313; HR, 1.034-1.664), fatigue (HR, 1.486; 95% CI, 1.158-1.907), and cognitive symptoms (HR, 1.815; 95% CI, 1.235-2.668). Moreover, the COVID-19 group had a significantly higher risk of the composite outcomes during all-cause ED visits, hospitalizations, and deaths when compared with the influenza group (27.5% vs. 21.7; HR, 1.303; 95% CI, 1.194-1.422).
This study indicates that hospitalized COVID-19 patients are at a higher risk of long-term complications when compared with influenza survivors.
This study assessed the clinical efficacy of nirmatrelvir plus ritonavir (NMV‐r) in treating patients with coronavirus disease‐2019 (COVID‐19) and substance use disorders (SUDs). This study included ...two cohorts: the first examined patients with SUDs, with and without a prescription for NMV‐r, while the second compared patients prescribed with NMV‐r, with and without a diagnosis of SUDs. SUDs were defined using ICD‐10 codes, related to SUDs, including alcohol, cannabis, cocaine, opioid, and tobacco use disorders (TUD). Patients with underlying SUDs and COVID‐19 were identified using the TriNetX network. We used 1:1 propensity score matching to create balanced groups. The primary outcome of interest was the composite outcome of all‐cause hospitalization or death within 30 days. Propensity score matching yielded two matched groups of 10 601 patients each. The results showed that the use of NMV‐r was associated with a lower risk of hospitalization or death, 30 days after COVID‐19 diagnosis (hazard ratio (HR), 0.640; 95% confidence interval (CI): 0.543–0.754), as well as a lower risk of all‐cause hospitalization (HR, 0.699; 95% CI: 0.592–0.826) and all‐cause death (HR, 0.084; 95% CI: 0.026–0.273). However, patients with SUDs had a higher risk of hospitalized or death within 30 days of COVID‐19 diagnosis than those without SUDs, even with the use of NMV‐r (HR, 1.783; 95% CI: 1.399–2.271). The study also found that patients with SUDs had a higher prevalence of comorbidities and adverse socioeconomic determinants of health than those without SUDs. Subgroup analysis showed that the benefits of NMV‐r were consistent across most subgroups with different characteristics, including age (patients aged ≥60 years HR, 0.507; 95% CI: 0.402–0.640), sex (women HR, 0.636; 95% CI: 0.517–0.783 and men HR, 0.480; 95% CI: 0.373–0.618), vaccine status (vaccinated <2 doses HR, 0.514; 95% CI: 0.435–0.608), SUD subtypes (alcohol use disorder HR, 0.711; 95% CI: 0.511– 0.988, TUD HR, 0.666; 95% CI: 0.555–0.800) and Omicron wave (HR, 0.624; 95% CI: 0.536–0.726). Our findings indicate that NMV‐r could reduce all‐cause hospitalization and death in the treatment of COVID‐19 among patients with SUDs and support the use of NMV‐r for treating patients with SUDs and COVID‐19.
