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Risk factors of COVID-19 mortality: a systematic review of current literature and lessons from recent retracted articles

Authors
 K H Lee  ;  J S Kim  ;  S H Hong  ;  D Seong  ;  Y R Choi  ;  Y T Ahn  ;  K S Kim  ;  S E Kim  ;  S Lee  ;  W Sim  ;  D Kim  ;  B Jun  ;  J W Yang  ;  D K Yon  ;  S W Lee  ;  M S Kim  ;  E Dragioti  ;  H Li  ;  L Jacob  ;  A Koyanagi  ;  R Abou Ghayda  ;  J I Shin  ;  L Smith 
Citation
 EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES, Vol.24(24) : 13089-13097, 2020-12 
Journal Title
EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES
ISSN
 1128-3602 
Issue Date
2020-12
MeSH
African Continental Ancestry Group / statistics & numerical data ; Age Factors ; Angiotensin Receptor Antagonists / therapeutic use* ; Angiotensin-Converting Enzyme Inhibitors / therapeutic use* ; Asian Continental Ancestry Group / statistics & numerical data ; COVID-19 / drug therapy ; COVID-19 / epidemiology ; COVID-19 / immunology ; COVID-19 / mortality* ; Coronary Artery Disease / epidemiology ; Databases, Factual ; Diabetes Mellitus / epidemiology ; Drug Therapy, Combination ; Enzyme Inhibitors / therapeutic use* ; Heart Failure / epidemiology ; Humans ; Hydroxychloroquine / therapeutic use* ; Hypertension / epidemiology ; Immunocompromised Host / immunology ; Information Dissemination ; Macrolides / therapeutic use ; Obesity / epidemiology ; Organ Dysfunction Scores ; Protective Factors ; Pulmonary Disease, Chronic Obstructive / epidemiology ; Randomized Controlled Trials as Topic ; Retraction of Publication as Topic* ; Risk Factors ; SARS-CoV-2 ; Severity of Illness Index ; Sex Factors ; Smoking / epidemiology
Abstract
Objective: Recently, two influential articles that reported the association of (hydroxy)chloroquine or angiotensin converting enzyme (ACE) inhibitors and coronavirus disease 2019 (COVID-19) mortality were retracted due to significant methodological issues. Therefore, we aimed to analyze the same clinical issues through an improved research method and to find out the differences from the retracted papers. We systematically reviewed pre-existing literature, and compared the results with those of the retracted papers to gain a novel insight.

Materials and methods: We extracted common risk factors identified in two retracted papers, and conducted relevant publication search until June 26, 2020 in PubMed. Then, we analyzed the risk factors for COVID-19 mortality and compared them to those of the retracted papers.

Results: Our systematic review demonstrated that most demographic and clinical risk factors for COVID-19 mortality were similar to those of the retracted papers. However, while the retracted paper indicated that both (hydroxy)chloroquine monotherapy and combination therapy with macrolide were associated with higher risk of mortality, our study showed that only combination therapy of hydroxychloroquine and macrolide was associated with higher risk of mortality (odds ratio 2.33; 95% confidence interval 1.63-3.34). In addition, our study demonstrated that use of ACE inhibitors or angiotensin receptor blockers (ARBs) was associated with reduced risk of mortality (0.77; 0.65-0.91).

Conclusions: When analyzing the same clinical issues with the two retracted papers through a systematic review of randomized controlled trials and relevant cohort studies, we found out that (hydroxy)chloroquine monotherapy was not associated with higher risk of mortality, and that the use of ACE inhibitors or ARBs was associated with reduced risk of mortality in COVID-19 patients.
Files in This Item:
T202006188.pdf Download
DOI
10.26355/eurrev_202012_24216
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Shin, Jae Il(신재일) ORCID logo https://orcid.org/0000-0003-2326-1820
Lee, Keum Hwa(이금화) ORCID logo https://orcid.org/0000-0002-1511-9587
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182548
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