The following article is a part of conference coverage from CHEST 2021, being held virtually from October 17 to October 20, 2021. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from CHEST 2021.

 

Acetaminophen, which is commonly used to reduce fever in individuals with COVID-19, has been associated with worse outcomes for that disease, according to results of research presented at the CHEST 2021 Annual Meeting, held virtually October 17 to 20.


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Investigators hypothesized that a clinical correlation exists between acetaminophen dose and patient outcomes, recognizing that the antipyretic agent inhibits prostaglandin production in the brain, leading to increased production of pro-inflammatory cytokines, such as interleukin 6, which has been linked to poor outcomes in COVID-19. To test their hypothesis, researchers conducted a retrospective analysis of acetaminophen use in adult patients admitted to the Washington Hospital Center in Washington, DC, between February 2020 and June 2020. Individuals who were admitted directly to the intensive care unit were excluded from the study.

Acetaminophen exposure was calculated using a formula for average adjusted daily acetaminophen dose: total acetaminophen dosage divided by the number of days that the medication was administered. Patients were stratified into exposed and nonexposed groups. The exposed arm was further divided into moderate exposure

(100 to 1000 mg/day of acetaminophen) or high exposure (>1000 mg/day of acetaminophen) segments.

A total of 524 patients were included in the study cohort, with 136 individuals in the nonexposed group, 256 in the moderate exposure group, and 132 in the high exposure group. Per multivariable logistic regression, those patients who were exposed to acetaminophen had a significantly higher likelihood of being triaged to a higher level of care in the moderate exposure arm (odds ratio [OR], 3.01; 95% CI, 1.40-7.07; P <.007) and in the high exposure arm (OR, 3.44; 95% CI, 1.49-8.54; P <.005).

Secondary outcomes included significantly longer length of hospital stay (5 days vs

10 days, respectively; P <.001), significantly higher rates of mortality (5.1% vs 16.5%, respectively; P =.001), and significantly increased risk of requiring ventilator support (2.9% vs 15.5%, respectively; P <.001) in the nonexposed group compared with the exposed groups, respectively.

The researchers concluded that additional studies are warranted in order to explore the relationship between acetaminophen and COVID-19 outcomes. In particular, research is needed to determine whether there is an independent association between this study’s acetaminophen-related outcomes and patients with COVID-19 who experience a greater number of febrile episodes. If, in fact, a true association does exist between acetaminophen use and worse outcomes among individuals with viral respiratory illnesses, extra caution would be required when prescribing the antipyretic agent in hospital settings, researchers noted.

Reference                                                                                                                                                                             

Manjani L, Desai N, Kohli A, Arya R, Woods C, Desale S. Effects of acetaminophen on outcomes in patients hospitalized with COVID-10. Presented at: CHEST 2021; October 17-20, 2021; Orlando, FL/Virtual. Abstract  A1072.