Ascorbic Acid as an Adjunctive Therapy in Critically Ill Patients with COVID-19: A Multicenter Propensity Score Matched Study

Abstract Background: Ascorbic acid represents an appealing option for clinicians to utilize in the context of a global health pandemic of COVID-19 patients due to its proposed clinical efficacy, relative safety, and low cost.Objectives:The aim of this study was to evaluate the efficacy and safety of using ascorbic acid in supplemental dose as adjunctive therapy in critically ill patients with COVID-19. Methods: This was a multi-center, non-interventional, retrospective cohort study. All critically ill adult patients admitted to ICU with a confirmed COVID-19 between March 1st to December 31st, 2020 were included in the final analysis. The study was conducted at two large governmental tertiary hospitals in Saudi Arabia. The purpose was to investigate the association between clinical outcomes with ascorbic acid use as an adjunctive therapy in COVID-19 after propensity score matching using baseline severity scores, systemic use of corticosteroids and study centers. Results:A 739 patients were included in this study; 296 patients were included after propensity score matching. There was no association between the administration of ascorbic acid and in-hospital mortality nor 30-day ICU mortality (OR (95%CI): 0.77 (0.476, 1.234), p-value=0.2738 and OR (95%CI): 0.73 (0.438 ,1.204), p-value=0.215 respectively). Using ascorbic acid was associated with lower incidence of thrombosis compared with the non-ascorbic acid group (6.1% vs. 13% respectively); OR (95%CI): 0.42 (0.184, 0.937), p-value=0.0342).Conclusion:Supplemental dose of ascorbic acid as an adjunctive therapy in COVID19 critically ill patients was not associated with mortality benefits; but associated with lower incidence of thrombosis. Further studies are required to confirm these findings.

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Adjunctive Therapy with Ascorbic in Critically Ill Patients with COVID-19: A Multicenter Propensity Score Matched Study

10.21203/rs.3.rs-227158/v1 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Al Juhani ◽

Hisham A. Badreldin ◽

Khalid Bin Salah ◽

Abdullah Al Harthi ◽

...

Keyword(s):

Ascorbic Acid ◽

Propensity Score ◽

Propensity Score Matching ◽

Critically Ill ◽

Critically Ill Patients ◽

Lower Incidence ◽

Adjunctive Therapy ◽

P Value ◽

Relative Safety ◽

Severity Scores

Abstract Background: Due to its supposed clinical efficacy, relative safety, and low cost, ascorbic acid represents an appealing option for clinicians to utilize in the context of a global health pandemic of COVID-19 patients.Objectives: The aim of this study was to evaluate the efficacy and safety of using ascorbic acid as adjunctive therapy in critically ill patients with COVID-19. Methods: This was a multi-center, non-interventional, retrospective cohort study. All critically ill adult patients admitted to ICU with a confirmed COVID-19 between March 1st to December 31st, 2020 were included in the final analysis. The study was conducted at two large governmental tertiary hospitals in Saudi Arabia. The purpose was to investigate the association between clinical outcomes with ascorbic acid use as an adjunctive therapy in COVID-19 after propensity score matching using baseline severity scores, systemic use of corticosteroids and study centers. Results: A 739 patients were included in this study; 296 patients were included after propensity score matching. There was no association between the administration of ascorbic acid and in-hospital mortality nor 30-day ICU mortality (OR (95%CI): 0.77 (0.476, 1.234), p-value=0.2738 and OR (95%CI): 0.73 (0.438 ,1.204), p-value=0.215 respectively). Using ascorbic acid was associated with lower incidence of thrombosis compared with the non-ascorbic acid group (6.1% vs. 13% respectively); OR (95%CI): 0.42 (0.184, 0.937), p-value=0.0342).Conclusion: Ascorbic acid use as an adjunctive therapy in COVID19 critically ill patients was not associated with mortality benefits; but associated with lower incidence of thrombosis. Further studies are required to confirm these findings.

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Ascorbic acid as an adjunctive therapy in critically ill patients with COVID-19: a propensity score matched study

Scientific Reports ◽

10.1038/s41598-021-96703-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Aljuhani ◽

Khalid Bin Saleh ◽

Hisham A. Badreldin ◽

Abdullah Al Harthi ◽

...

Keyword(s):

Ascorbic Acid ◽

Propensity Score ◽

Propensity Score Matching ◽

Critically Ill ◽

Critically Ill Patients ◽

Lower Incidence ◽

Adjunctive Therapy ◽

Low Dose ◽

P Value ◽

Severity Scores

AbstractAscorbic acid represents an appealing option for clinicians to utilize in the context of the global COVID-19 pandemic due to its proposed clinical efficacy, relative safety, and low cost. The aim of this study was to evaluate the efficacy and safety of using ascorbic acid in supplemental doses as adjunctive therapy for patients critically ill with COVID-19. This was a two-center, non-interventional, retrospective cohort study. All critically ill adult patients admitted to ICU with a confirmed COVID-19 diagnosis between March 1st and December 31st, 2020, were included in the final analysis. The study was conducted at two large governmental tertiary hospitals in Saudi Arabia. The purpose was to investigate the clinical outcomes of low-dose ascorbic acid as adjunctive therapy in COVID-19 after propensity score matching using baseline severity scores, systematic use of corticosteroids, and study centers. A number of 739 patients were included in this study, among whom 296 patients were included after propensity score matching. There was no association between the administration of ascorbic acid and in-hospital mortality or the 30-day mortality [OR (95% CI) 0.77 (0.47, 1.23), p value = 0.27 and OR (95% CI) 0.73 (0.43, 1.20), p value = 0.21, respectively]. Using ascorbic acid was associated with a lower incidence of thrombosis compared with the non-ascorbic-acid group [6.1% vs. 13% respectively; OR (95% CI) 0.42 (0.184, 0.937), p value = 0.03]. Low dose of ascorbic acid as an adjunctive therapy in COVID-19 critically ill patients was not associated with mortality benefits, but it was associated with a lower incidence of thrombosis. Further studies are required to confirm these findings.

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Evaluation of Thiamine as Adjunctive Therapy in COVID-19 Critically Ill Patients: A Multicenter Propensity Score Matched Study

10.21203/rs.3.rs-400565/v1 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Aljuhani ◽

Maram Al Dossari ◽

Asma Alshahrani ◽

Aisha Alharbi ◽

...

Keyword(s):

Propensity Score ◽

Critically Ill ◽

Critically Ill Patients ◽

Adjunctive Therapy ◽

Thiamine Pyrophosphate ◽

P Value ◽

Immune System Function ◽

Severity Scores ◽

Matched Study

Abstract Background: Thiamine is a precursor of the essential coenzyme thiamine pyrophosphate (TPP) required for glucose metabolism; it improves the immune system function and has been shown to reduce the risk of several diseases. The role of thiamine in COVID-19 critically ill patients is still unclear, however, its role in the critically ill septic patient has been addressed in multiple studies. The objective of this study was to evaluate the use of thiamine as adjunctive therapy on the mortality in COVID 19 critically ill patients. Methods: This is a multicenter, non-interventional, retrospective cohort study for all critically ill patients admitted to intensive care units (ICUs) with a confirmed diagnosis of COVID19. All patients aged 18 years or older who were admitted to ICUs between March 1st to December 31st, 2020 with positive PCR COVID-19 were included in the study. We investigated the association between thiamine use as an adjunctive therapy and clinical outcomes in COVID -19 after propensity score matching using baseline severity scores, systemic use of corticosteroids and study centers. Results: A total of 738 critically ill patients with COVID-19 who had been admitted in ICUs at the two governmental hospitals included in the study. Among 166 patients matched using propensity score, 83 had received thiamine as adjunctive therapy. There was significant association between thiamine use with in-hospital mortality (OR=0.49; 95% CI = 0.25- 0.97; P=0.04) as well with 30-day ICU mortality (OR=0.45; 95% CI = 0.215- 0.935; P=0.03). Moreover, patients who received thiamine as an adjunctive therapy were less likely to have thrombosis during ICU stay by 81 % (OR (95%CI): 0.19 (0.040,0.884), p-value=0.034).Conclusion: Thiamine use as an adjunctive therapy may have potential survival benefits in critically ill patients with COVID-19.

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Author Correction: Ascorbic acid as an adjunctive therapy in critically ill patients with COVID-19: a propensity score matched study

Scientific Reports ◽

10.1038/s41598-021-99146-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Aljuhani ◽

Khalid Bin Saleh ◽

Hisham A. Badreldin ◽

Abdullah Al Harthi ◽

...

Keyword(s):

Ascorbic Acid ◽

Propensity Score ◽

Critically Ill ◽

Critically Ill Patients ◽

Adjunctive Therapy ◽

Matched Study

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Evaluation of Zinc Sulfate as an Adjunctive Therapy in COVID-19 Critically Ill Patients: a Two Center Propensity-score Matched Study

10.21203/rs.3.rs-572942/v1 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Al Juhani ◽

Abdulrahman I Al Shaya ◽

Abdullah Kharbosh ◽

Raed Kensara ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Critically Ill ◽

Critically Ill Patients ◽

Adjunctive Therapy ◽

Zinc Sulfate ◽

Kidney Injury ◽

Icu Stay ◽

Increased Risk ◽

Beta Coefficient

Abstract Background: Zinc is a trace element that plays a role in stimulating innate and acquired immunity. The role of zinc in critically ill patients with COVID-19 remains unclear. This study aims to evaluate the efficacy and safety of zinc sulfate as adjunctive therapy in critically ill patients with COVID-19.Methods: Patients aged ≥ 18 years with a COVID-19 who were admitted to the intensive care unit (ICU) in two tertiary hospitals in Saudi Arabia were retrospectively assessed for zinc use, from 01 March 2020 until 31-December 2020. We assessed the association of zinc use as adjunctive therapy with the in-hospital and 30-day mortality after propensity score matching. Secondary outcomes included mechanical ventilation (MV) duration, ICU length of stay (LOS), hospital LOS, and complication (s) during ICU stay. Results: A total of 266 patients were included in this study after using propensity score matching. Zinc sulfate as adjunctive therapy during ICU stay was not associated with statistically significant reduction in 30-day mortality nor in-hospital mortality compared to those who did not receive zinc (HR= 0.65 CI = 0.41,1.01; p= 0.05 and HR= 0.67 CI = 0.45,1.00; p= 0.05; respectively). Moreover, MV duration (Beta coefficient 0.10 CI = -0.19,0.39; p= 0.48), ICU LOS (Beta coefficient 0.19 CI = -0.02,0.40; p=0.08) and hospital LOS (Beta coefficient 0.15 CI = -0.02,0.32; p=0.08) were not statistically significant between the two groups. Patients who received zinc have a higher odds of acute kidney injury (AKI) during ICU stay (OR= 1.80 CI = 1.08-3.0; p= 0.02). Conclusion: Zinc sulfate as adjunctive therapy in critically ill patients with COVID-19 may have survival benefit; however, was not statistically significant. Zinc use was linked with an increased risk of AKI development during ICU stay.

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Evaluation of zinc sulfate as an adjunctive therapy in COVID-19 critically ill patients: a two center propensity-score matched study

Critical Care ◽

10.1186/s13054-021-03785-1 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Aljuhani ◽

Abdulrahman I. Al Shaya ◽

Abdullah Kharbosh ◽

Raed Kensara ◽

...

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Adjunctive Therapy ◽

Zinc Sulfate ◽

Statistical Significance ◽

Kidney Injury ◽

Additional Treatment ◽

Icu Stay

Abstract Background Zinc is a trace element that plays a role in stimulating innate and acquired immunity. The role of zinc in critically ill patients with COVID-19 remains unclear. This study aims to evaluate the efficacy and safety of zinc sulfate as adjunctive therapy in critically ill patients with COVID-19. Methods Patients aged ≥ 18 years with COVID-19 who were admitted to the intensive care unit (ICU) in two tertiary hospitals in Saudi Arabia were retrospectively assessed for zinc use from March 1, 2020 until March 31, 2021. After propensity score matching (1:1 ratio) based on the selected criteria, we assessed the association of zinc used as adjunctive therapy with the 30-day mortality. Secondary outcomes included the in-hospital mortality, ventilator free days, ICU length of stay (LOS), hospital LOS, and complication (s) during ICU stay. Results A total of 164 patients were included, 82 patients received zinc. Patients who received zinc sulfate as adjunctive therapy have a lower 30-day mortality (HR 0.52, CI 0.29, 0.92; p = 0.03). On the other hand, the in-hospital mortality was not statistically significant between the two groups (HR 0.64, CI 0.37–1.10; p = 0.11). Zinc sulfate use was associated with a lower odds of acute kidney injury development during ICU stay (OR 0.46 CI 0.19–1.06; p = 0.07); however, it did not reach statistical significance. Conclusion The use of zinc sulfate as an additional treatment in critically ill COVID-19 patients may improve survival. Furthermore, zinc supplementation may have a protective effect on the kidneys.

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Prognostic value of neutrophil–lymphocyte ratio in critically ill patients with cancer: a propensity score matching study

Clinical & Translational Oncology ◽

10.1007/s12094-020-02405-8 ◽

2020 ◽

Author(s):

Z.-Q. Chen ◽

X.-S. Yu ◽

L.-J. Mao ◽

R. Zheng ◽

L.-L. Xue ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Critically Ill ◽

Critically Ill Patients ◽

Prognostic Value ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Patients With Cancer

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Evaluation of low-dose aspirin use among COVID-19 critically ill patients: A Multicenter Propensity Score Matched Study

10.21203/rs.3.rs-872891/v2 ◽

2021 ◽

Author(s):

Abdullah Al Harthi ◽

Khalid Al Sulaiman ◽

Ohoud Aljuhani ◽

Ghazwa B. Korayem ◽

Ali F. Altebainawi ◽

...

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Low Dose ◽

P Value ◽

Icu Stay ◽

Dose Aspirin ◽

Low Dose Aspirin ◽

Anti Inflammatory

Abstract BackgroundMultiple medications with anti-inflammatory effects have been used to manage the hyper-inflammatory response associated with COVID-19. Aspirin is used widely as a cardioprotective agent due to its antiplatelet and anti-inflammatory properties. Its role in hospitalized COVID-19 patients has been assessed and evaluated in the literature. However, no data regards its role in COVID-19 critically ill patients. Therefore, this study aims to evaluate the use of low-dose aspirin (81-100 mg) and its impact on outcomes in COVID-19 critically ill patients. MethodThis is a multicenter, retrospective cohort study for all adult critically ill patients with confirmed COVID-19 admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on aspirin use during ICU stay. The primary outcome is the in-hospital mortality; other outcomes were considered secondary. Propensity score-matched used based on patient’s age, SOFA score, MV status within 24 hours of ICU admission, prone position status, ischemic heart disease (IHD), and stroke as co-existing illness. We considered a P value of < 0.05 statistically significant.ResultsA total of 1033 patients were eligible; 352 patients were included after propensity score matching (1:1 ratio). The in-hospital mortality (HR (95%CI): 0.73 (0.56, 0.97), p-value=0.03) were lower in patients who received aspirin during hospital stay. On the other hand, patients who received aspirin have a higher risk of major bleeding compared to the control group (OR (95%CI): 2.92 (0.91, 9.36), p-value=0.07); but was not statistically significant.ConclusionAspirin use in COVID-19 critically ill patients may have a mortality benefit; nevertheless, it may be linked with an increased risk of significant bleeding. The benefit-risk evaluation for aspirin usage during an ICU stay should be tailored to each patient.

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