Imperial College London, National Heart & Lung Institute, London, UK.
Royal Brompton Hospital, London, UK.
Br J Clin Pharmacol. 2021 Mar;87(3):776-784. doi: 10.1111/bcp.14514. Epub 2020 Aug 24.
In light of the recent safety concerns relating to NSAID use in COVID-19, we sought to evaluate cardiovascular and respiratory complications in patients taking NSAIDs during acute lower respiratory tract infections.
We carried out a systematic review of randomised controlled trials and observational studies. Studies of adult patients with short-term NSAID use during acute lower respiratory tract infections, including bacterial and viral infections, were included. Primary outcome was all-cause mortality. Secondary outcomes were cardiovascular, renal and respiratory complications.
In total, eight studies including two randomised controlled trials, three retrospective and three prospective observational studies enrolling 44 140 patients were included. Five of the studies were in patients with pneumonia, two in patients with influenza, and one in a patient with acute bronchitis. Meta-analysis was not possible due to significant heterogeneity. There was a trend towards a reduction in mortality and an increase in pleuro-pulmonary complications. However, all studies exhibited high risks of bias, primarily due to lack of adjustment for confounding variables. Cardiovascular outcomes were not reported by any of the included studies.
In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution. Mechanistic and clinical studies addressing the captioned subject are urgently needed, especially in relation to COVID-19.
鉴于最近与 COVID-19 期间使用 NSAID 相关的安全性问题，我们试图评估在急性下呼吸道感染期间服用 NSAID 的患者的心血管和呼吸系统并发症。
我们进行了一项系统评价，纳入了随机对照试验和观察性研究。研究对象为短期使用 NSAID 的急性下呼吸道感染（包括细菌和病毒感染）的成年患者。主要结局是全因死亡率。次要结局为心血管、肾脏和呼吸系统并发症。
共纳入 8 项研究，包括 2 项随机对照试验、3 项回顾性研究和 3 项前瞻性观察性研究，共纳入 44140 例患者。其中 5 项研究的对象为肺炎患者，2 项研究的对象为流感患者，1 项研究的对象为急性支气管炎患者。由于存在显著异质性，因此无法进行荟萃分析。死亡率呈下降趋势，胸膜肺并发症增加。然而，所有研究均存在较高的偏倚风险，主要是由于缺乏对混杂变量的调整。纳入的研究均未报告心血管结局。
在这项关于成人急性下呼吸道感染期间使用 NSAID 的系统评价中，我们发现，现有关于死亡率、胸膜肺并发症以及机械通气或器官衰竭发生率的证据质量极差、确定性极低，应谨慎解读。迫切需要针对上述主题进行机制和临床研究，特别是与 COVID-19 相关的研究。
