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  1. Article ; Online: An evaluation of GPT models for phenotype concept recognition.

    Groza, Tudor / Caufield, Harry / Gration, Dylan / Baynam, Gareth / Haendel, Melissa A / Robinson, Peter N / Mungall, Christopher J / Reese, Justin T

    BMC medical informatics and decision making

    2024  Volume 24, Issue 1, Page(s) 30

    Abstract: Objective: Clinical deep phenotyping and phenotype annotation play a critical role in both the diagnosis of patients with rare disorders as well as in building computationally-tractable knowledge in the rare disorders field. These processes rely on ... ...

    Abstract Objective: Clinical deep phenotyping and phenotype annotation play a critical role in both the diagnosis of patients with rare disorders as well as in building computationally-tractable knowledge in the rare disorders field. These processes rely on using ontology concepts, often from the Human Phenotype Ontology, in conjunction with a phenotype concept recognition task (supported usually by machine learning methods) to curate patient profiles or existing scientific literature. With the significant shift in the use of large language models (LLMs) for most NLP tasks, we examine the performance of the latest Generative Pre-trained Transformer (GPT) models underpinning ChatGPT as a foundation for the tasks of clinical phenotyping and phenotype annotation.
    Materials and methods: The experimental setup of the study included seven prompts of various levels of specificity, two GPT models (gpt-3.5-turbo and gpt-4.0) and two established gold standard corpora for phenotype recognition, one consisting of publication abstracts and the other clinical observations.
    Results: The best run, using in-context learning, achieved 0.58 document-level F1 score on publication abstracts and 0.75 document-level F1 score on clinical observations, as well as a mention-level F1 score of 0.7, which surpasses the current best in class tool. Without in-context learning, however, performance is significantly below the existing approaches.
    Conclusion: Our experiments show that gpt-4.0 surpasses the state of the art performance if the task is constrained to a subset of the target ontology where there is prior knowledge of the terms that are expected to be matched. While the results are promising, the non-deterministic nature of the outcomes, the high cost and the lack of concordance between different runs using the same prompt and input make the use of these LLMs challenging for this particular task.
    MeSH term(s) Humans ; Knowledge ; Language ; Machine Learning ; Phenotype ; Rare Diseases
    Language English
    Publishing date 2024-01-31
    Publishing country England
    Document type Journal Article
    ZDB-ID 2046490-3
    ISSN 1472-6947 ; 1472-6947
    ISSN (online) 1472-6947
    ISSN 1472-6947
    DOI 10.1186/s12911-024-02439-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: On the limitations of large language models in clinical diagnosis.

    Reese, Justin T / Danis, Daniel / Caufield, J Harry / Groza, Tudor / Casiraghi, Elena / Valentini, Giorgio / Mungall, Christopher J / Robinson, Peter N

    medRxiv : the preprint server for health sciences

    2024  

    Abstract: Objective: Large Language Models such as GPT-4 previously have been applied to differential diagnostic challenges based on published case reports. Published case reports have a sophisticated narrative style that is not readily available from typical ... ...

    Abstract Objective: Large Language Models such as GPT-4 previously have been applied to differential diagnostic challenges based on published case reports. Published case reports have a sophisticated narrative style that is not readily available from typical electronic health records (EHR). Furthermore, even if such a narrative were available in EHRs, privacy requirements would preclude sending it outside the hospital firewall. We therefore tested a method for parsing clinical texts to extract ontology terms and programmatically generating prompts that by design are free of protected health information.
    Materials and methods: We investigated different methods to prepare prompts from 75 recently published case reports. We transformed the original narratives by extracting structured terms representing phenotypic abnormalities, comorbidities, treatments, and laboratory tests and creating prompts programmatically.
    Results: Performance of all of these approaches was modest, with the correct diagnosis ranked first in only 5.3-17.6% of cases. The performance of the prompts created from structured data was substantially worse than that of the original narrative texts, even if additional information was added following manual review of term extraction. Moreover, different versions of GPT-4 demonstrated substantially different performance on this task.
    Discussion: The sensitivity of the performance to the form of the prompt and the instability of results over two GPT-4 versions represent important current limitations to the use of GPT-4 to support diagnosis in real-life clinical settings.
    Conclusion: Research is needed to identify the best methods for creating prompts from typically available clinical data to support differential diagnostics.
    Language English
    Publishing date 2024-02-26
    Publishing country United States
    Document type Preprint
    DOI 10.1101/2023.07.13.23292613
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Structured Prompt Interrogation and Recursive Extraction of Semantics (SPIRES): a method for populating knowledge bases using zero-shot learning.

    Caufield, J Harry / Hegde, Harshad / Emonet, Vincent / Harris, Nomi L / Joachimiak, Marcin P / Matentzoglu, Nicolas / Kim, HyeongSik / Moxon, Sierra / Reese, Justin T / Haendel, Melissa A / Robinson, Peter N / Mungall, Christopher J

    Bioinformatics (Oxford, England)

    2024  Volume 40, Issue 3

    Abstract: Motivation: Creating knowledge bases and ontologies is a time consuming task that relies on manual curation. AI/NLP approaches can assist expert curators in populating these knowledge bases, but current approaches rely on extensive training data, and ... ...

    Abstract Motivation: Creating knowledge bases and ontologies is a time consuming task that relies on manual curation. AI/NLP approaches can assist expert curators in populating these knowledge bases, but current approaches rely on extensive training data, and are not able to populate arbitrarily complex nested knowledge schemas.
    Results: Here we present Structured Prompt Interrogation and Recursive Extraction of Semantics (SPIRES), a Knowledge Extraction approach that relies on the ability of Large Language Models (LLMs) to perform zero-shot learning and general-purpose query answering from flexible prompts and return information conforming to a specified schema. Given a detailed, user-defined knowledge schema and an input text, SPIRES recursively performs prompt interrogation against an LLM to obtain a set of responses matching the provided schema. SPIRES uses existing ontologies and vocabularies to provide identifiers for matched elements. We present examples of applying SPIRES in different domains, including extraction of food recipes, multi-species cellular signaling pathways, disease treatments, multi-step drug mechanisms, and chemical to disease relationships. Current SPIRES accuracy is comparable to the mid-range of existing Relation Extraction methods, but greatly surpasses an LLM's native capability of grounding entities with unique identifiers. SPIRES has the advantage of easy customization, flexibility, and, crucially, the ability to perform new tasks in the absence of any new training data. This method supports a general strategy of leveraging the language interpreting capabilities of LLMs to assemble knowledge bases, assisting manual knowledge curation and acquisition while supporting validation with publicly-available databases and ontologies external to the LLM.
    Availability and implementation: SPIRES is available as part of the open source OntoGPT package: https://github.com/monarch-initiative/ontogpt.
    MeSH term(s) Semantics ; Knowledge Bases ; Databases, Factual
    Language English
    Publishing date 2024-02-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 1422668-6
    ISSN 1367-4811 ; 1367-4803
    ISSN (online) 1367-4811
    ISSN 1367-4803
    DOI 10.1093/bioinformatics/btae104
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Book ; Online: An evaluation of GPT models for phenotype concept recognition

    Groza, Tudor / Caufield, Harry / Gration, Dylan / Baynam, Gareth / Haendel, Melissa A / Robinson, Peter N / Mungall, Christopher J / Reese, Justin T

    2023  

    Abstract: Objective: Clinical deep phenotyping and phenotype annotation play a critical role in both the diagnosis of patients with rare disorders as well as in building computationally-tractable knowledge in the rare disorders field. These processes rely on using ...

    Abstract Objective: Clinical deep phenotyping and phenotype annotation play a critical role in both the diagnosis of patients with rare disorders as well as in building computationally-tractable knowledge in the rare disorders field. These processes rely on using ontology concepts, often from the Human Phenotype Ontology, in conjunction with a phenotype concept recognition task (supported usually by machine learning methods) to curate patient profiles or existing scientific literature. With the significant shift in the use of large language models (LLMs) for most NLP tasks, we examine the performance of the latest Generative Pre-trained Transformer (GPT) models underpinning ChatGPT as a foundation for the tasks of clinical phenotyping and phenotype annotation. Materials and Methods: The experimental setup of the study included seven prompts of various levels of specificity, two GPT models (gpt-3.5-turbo and gpt-4.0) and two established gold standard corpora for phenotype recognition, one consisting of publication abstracts and the other clinical observations. Results: Our results show that, with an appropriate setup, these models can achieve state of the art performance. The best run, using few-shot learning, achieved 0.58 macro F1 score on publication abstracts and 0.75 macro F1 score on clinical observations, the former being comparable with the state of the art, while the latter surpassing the current best in class tool. Conclusion: While the results are promising, the non-deterministic nature of the outcomes, the high cost and the lack of concordance between different runs using the same prompt and input make the use of these LLMs challenging for this particular task.
    Keywords Computer Science - Computation and Language ; Computer Science - Artificial Intelligence
    Subject code 006
    Publishing date 2023-09-29
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Predictive models of long COVID.

    Antony, Blessy / Blau, Hannah / Casiraghi, Elena / Loomba, Johanna J / Callahan, Tiffany J / Laraway, Bryan J / Wilkins, Kenneth J / Antonescu, Corneliu C / Valentini, Giorgio / Williams, Andrew E / Robinson, Peter N / Reese, Justin T / Murali, T M

    EBioMedicine

    2023  Volume 96, Page(s) 104777

    Abstract: Background: The cause and symptoms of long COVID are poorly understood. It is challenging to predict whether a given COVID-19 patient will develop long COVID in the future.: Methods: We used electronic health record (EHR) data from the National COVID ...

    Abstract Background: The cause and symptoms of long COVID are poorly understood. It is challenging to predict whether a given COVID-19 patient will develop long COVID in the future.
    Methods: We used electronic health record (EHR) data from the National COVID Cohort Collaborative to predict the incidence of long COVID. We trained two machine learning (ML) models - logistic regression (LR) and random forest (RF). Features used to train predictors included symptoms and drugs ordered during acute infection, measures of COVID-19 treatment, pre-COVID comorbidities, and demographic information. We assigned the 'long COVID' label to patients diagnosed with the U09.9 ICD10-CM code. The cohorts included patients with (a) EHRs reported from data partners using U09.9 ICD10-CM code and (b) at least one EHR in each feature category. We analysed three cohorts: all patients (n = 2,190,579; diagnosed with long COVID = 17,036), inpatients (149,319; 3,295), and outpatients (2,041,260; 13,741).
    Findings: LR and RF models yielded median AUROC of 0.76 and 0.75, respectively. Ablation study revealed that drugs had the highest influence on the prediction task. The SHAP method identified age, gender, cough, fatigue, albuterol, obesity, diabetes, and chronic lung disease as explanatory features. Models trained on data from one N3C partner and tested on data from the other partners had average AUROC of 0.75.
    Interpretation: ML-based classification using EHR information from the acute infection period is effective in predicting long COVID. SHAP methods identified important features for prediction. Cross-site analysis demonstrated the generalizability of the proposed methodology.
    Funding: NCATS U24 TR002306, NCATS UL1 TR003015, Axle Informatics Subcontract: NCATS-P00438-B, NIH/NIDDK/OD, PSR2015-1720GVALE_01, G43C22001320007, and Director, Office of Science, Office of Basic Energy Sciences of the U.S. Department of Energy Contract No. DE-AC02-05CH11231.
    MeSH term(s) Humans ; Post-Acute COVID-19 Syndrome ; COVID-19 ; COVID-19 Drug Treatment ; Machine Learning ; Obesity
    Language English
    Publishing date 2023-09-04
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2851331-9
    ISSN 2352-3964
    ISSN (online) 2352-3964
    DOI 10.1016/j.ebiom.2023.104777
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Book ; Online: Structured prompt interrogation and recursive extraction of semantics (SPIRES)

    Caufield, J. Harry / Hegde, Harshad / Emonet, Vincent / Harris, Nomi L. / Joachimiak, Marcin P. / Matentzoglu, Nicolas / Kim, HyeongSik / Moxon, Sierra A. T. / Reese, Justin T. / Haendel, Melissa A. / Robinson, Peter N. / Mungall, Christopher J.

    A method for populating knowledge bases using zero-shot learning

    2023  

    Abstract: Creating knowledge bases and ontologies is a time consuming task that relies on a manual curation. AI/NLP approaches can assist expert curators in populating these knowledge bases, but current approaches rely on extensive training data, and are not able ... ...

    Abstract Creating knowledge bases and ontologies is a time consuming task that relies on a manual curation. AI/NLP approaches can assist expert curators in populating these knowledge bases, but current approaches rely on extensive training data, and are not able to populate arbitrary complex nested knowledge schemas. Here we present Structured Prompt Interrogation and Recursive Extraction of Semantics (SPIRES), a Knowledge Extraction approach that relies on the ability of Large Language Models (LLMs) to perform zero-shot learning (ZSL) and general-purpose query answering from flexible prompts and return information conforming to a specified schema. Given a detailed, user-defined knowledge schema and an input text, SPIRES recursively performs prompt interrogation against GPT-3+ to obtain a set of responses matching the provided schema. SPIRES uses existing ontologies and vocabularies to provide identifiers for all matched elements. We present examples of use of SPIRES in different domains, including extraction of food recipes, multi-species cellular signaling pathways, disease treatments, multi-step drug mechanisms, and chemical to disease causation graphs. Current SPIRES accuracy is comparable to the mid-range of existing Relation Extraction (RE) methods, but has the advantage of easy customization, flexibility, and, crucially, the ability to perform new tasks in the absence of any training data. This method supports a general strategy of leveraging the language interpreting capabilities of LLMs to assemble knowledge bases, assisting manual knowledge curation and acquisition while supporting validation with publicly-available databases and ontologies external to the LLM. SPIRES is available as part of the open source OntoGPT package: https://github.com/ monarch-initiative/ontogpt.
    Keywords Computer Science - Artificial Intelligence ; Computer Science - Machine Learning
    Subject code 004
    Publishing date 2023-04-05
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Book ; Online: MapperGPT

    Matentzoglu, Nicolas / Caufield, J. Harry / Hegde, Harshad B. / Reese, Justin T. / Moxon, Sierra / Kim, Hyeongsik / Harris, Nomi L. / Haendel, Melissa A / Mungall, Christopher J.

    Large Language Models for Linking and Mapping Entities

    2023  

    Abstract: Aligning terminological resources, including ontologies, controlled vocabularies, taxonomies, and value sets is a critical part of data integration in many domains such as healthcare, chemistry, and biomedical research. Entity mapping is the process of ... ...

    Abstract Aligning terminological resources, including ontologies, controlled vocabularies, taxonomies, and value sets is a critical part of data integration in many domains such as healthcare, chemistry, and biomedical research. Entity mapping is the process of determining correspondences between entities across these resources, such as gene identifiers, disease concepts, or chemical entity identifiers. Many tools have been developed to compute such mappings based on common structural features and lexical information such as labels and synonyms. Lexical approaches in particular often provide very high recall, but low precision, due to lexical ambiguity. As a consequence of this, mapping efforts often resort to a labor intensive manual mapping refinement through a human curator. Large Language Models (LLMs), such as the ones employed by ChatGPT, have generalizable abilities to perform a wide range of tasks, including question-answering and information extraction. Here we present MapperGPT, an approach that uses LLMs to review and refine mapping relationships as a post-processing step, in concert with existing high-recall methods that are based on lexical and structural heuristics. We evaluated MapperGPT on a series of alignment tasks from different domains, including anatomy, developmental biology, and renal diseases. We devised a collection of tasks that are designed to be particularly challenging for lexical methods. We show that when used in combination with high-recall methods, MapperGPT can provide a substantial improvement in accuracy, beating state-of-the-art (SOTA) methods such as LogMap.
    Keywords Computer Science - Computation and Language ; Computer Science - Artificial Intelligence
    Subject code 401
    Publishing date 2023-10-05
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: NSAID use and clinical outcomes in COVID-19 patients: a 38-center retrospective cohort study

    Reese, Justin T. / Coleman, Ben / Chan, Lauren / Blau, Hannah / Callahan, Tiffany J. / Cappelletti, Luca / Fontana, Tommaso / Bradwell, Katie R. / Harris, Nomi L. / Casiraghi, Elena / Valentini, Giorgio / Karlebach, Guy / Deer, Rachel / McMurry, Julie A. / Haendel, Melissa A. / Chute, Christopher G. / Pfaff, Emily / Moffitt, Richard / Spratt, Heidi /
    Singh, Jasvinder A. / Mungall, Christopher J. / Williams, Andrew E. / Robinson, Peter N.

    Virol J. 2022 Dec., v. 19, no. 1 p.84-84

    2022  

    Abstract: BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community-acquired pneumonia. Observations shortly after the start of the COVID-19 ... ...

    Abstract BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community-acquired pneumonia. Observations shortly after the start of the COVID-19 pandemic in 2020 suggested that ibuprofen was associated with an increased risk of adverse events in COVID-19 patients, but subsequent observational studies failed to demonstrate increased risk and in one case showed reduced risk associated with NSAID use. METHODS: A 38-center retrospective cohort study was performed that leveraged the harmonized, high-granularity electronic health record data of the National COVID Cohort Collaborative. A propensity-matched cohort of 19,746 COVID-19 inpatients was constructed by matching cases (treated with NSAIDs at the time of admission) and 19,746 controls (not treated) from 857,061 patients with COVID-19 available for analysis. The primary outcome of interest was COVID-19 severity in hospitalized patients, which was classified as: moderate, severe, or mortality/hospice. Secondary outcomes were acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO), invasive ventilation, and all-cause mortality at any time following COVID-19 diagnosis. RESULTS: Logistic regression showed that NSAID use was not associated with increased COVID-19 severity (OR: 0.57 95% CI: 0.53–0.61). Analysis of secondary outcomes using logistic regression showed that NSAID use was not associated with increased risk of all-cause mortality (OR 0.51 95% CI: 0.47–0.56), invasive ventilation (OR: 0.59 95% CI: 0.55–0.64), AKI (OR: 0.67 95% CI: 0.63–0.72), or ECMO (OR: 0.51 95% CI: 0.36–0.7). In contrast, the odds ratios indicate reduced risk of these outcomes, but our quantitative bias analysis showed E-values of between 1.9 and 3.3 for these associations, indicating that comparatively weak or moderate confounder associations could explain away the observed associations. CONCLUSIONS: Study interpretation is limited by the observational design. Recording of NSAID use may have been incomplete. Our study demonstrates that NSAID use is not associated with increased COVID-19 severity, all-cause mortality, invasive ventilation, AKI, or ECMO in COVID-19 inpatients. A conservative interpretation in light of the quantitative bias analysis is that there is no evidence that NSAID use is associated with risk of increased severity or the other measured outcomes. Our results confirm and extend analogous findings in previous observational studies using a large cohort of patients drawn from 38 centers in a nationally representative multicenter database.
    Keywords COVID-19 infection ; acute kidney injury ; cohort studies ; databases ; fever ; ibuprofen ; inflammation ; mortality ; pain ; pneumonia ; regression analysis ; risk ; risk reduction ; telemedicine
    Language English
    Dates of publication 2022-12
    Size p. 84.
    Publishing place BioMed Central
    Document type Article ; Online
    ZDB-ID 2160640-7
    ISSN 1743-422X
    ISSN 1743-422X
    DOI 10.1186/s12985-022-01813-2
    Database NAL-Catalogue (AGRICOLA)

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  9. Article ; Online: Metformin is Associated with Reduced COVID-19 Severity in Patients with Prediabetes

    Chan, Lauren E / Casiraghi, Elena / Laraway, Bryan J / Coleman, Ben / Blau, Hannah / Zaman, Adnin / Harris, Nomi L / Wilkins, Kenneth / Valentini, Giorgio / Sahner, David / Haendel, Melissa A / Robinson, Peter N / Bramante, Carolyn T / Reese, Justin T

    medRxiv

    Abstract: Background: With the continuing COVID-19 pandemic, identifying medications that improve COVID-19 outcomes is crucial. Studies suggest that use of metformin, an oral antihyperglycemic, is associated with reduced COVID-19 severity in individuals with ... ...

    Abstract Background: With the continuing COVID-19 pandemic, identifying medications that improve COVID-19 outcomes is crucial. Studies suggest that use of metformin, an oral antihyperglycemic, is associated with reduced COVID-19 severity in individuals with diabetes compared to other antihyperglycemic medications. Some patients without diabetes, including those with polycystic ovary syndrome (PCOS) and prediabetes, are prescribed metformin for off-label use, which provides an opportunity to further investigate the effect of metformin on COVID-19. Design: Leveraging the harmonized electronic health record data from 53 hospitals, we constructed cohorts of COVID-19 positive, metformin users without diabetes and propensity-weighted control users of levothyroxine (a medication for hypothyroidism that is not known to affect COVID-19 outcome) who had either PCOS (n = 282) or prediabetes (n = 3136). The primary outcome of interest was COVID-19 severity, which was classified as: mild, mild ED (emergency department), moderate, severe, or mortality/hospice. Results: In the prediabetes cohort, metformin use was associated with a lower rate of COVID-19 with severity of mild ED or worse (OR: 0.630, 95% CI 0.450 - 0.882, p < 0.05) and a lower rate of COVID-19 with severity of moderate or worse (OR: 0.490, 95% CI 0.336 - 0.715, p < 0.001). In patients with PCOS, we found no significant association between metformin use and COVID-19 severity, although the number of patients was relatively small. Conclusions: Metformin was associated with less severe COVID-19 in patients with prediabetes, as seen in previous studies of patients with diabetes. This is an important finding, since prediabetes affects between 19 and 38% of the US population, and COVID-19 is an ongoing public health emergency. Further observational and prospective studies will clarify the relationship between metformin and COVID-19 severity in patients with prediabetes, and whether metformin usage may reduce COVID-19 severity.
    Keywords covid19
    Language English
    Publishing date 2022-08-30
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2022.08.29.22279355
    Database COVID19

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  10. Article ; Online: NSAID use and clinical outcomes in COVID-19 patients: a 38-center retrospective cohort study.

    Reese, Justin T / Coleman, Ben / Chan, Lauren / Blau, Hannah / Callahan, Tiffany J / Cappelletti, Luca / Fontana, Tommaso / Bradwell, Katie R / Harris, Nomi L / Casiraghi, Elena / Valentini, Giorgio / Karlebach, Guy / Deer, Rachel / McMurry, Julie A / Haendel, Melissa A / Chute, Christopher G / Pfaff, Emily / Moffitt, Richard / Spratt, Heidi /
    Singh, Jasvinder A / Mungall, Christopher J / Williams, Andrew E / Robinson, Peter N

    Virology journal

    2022  Volume 19, Issue 1, Page(s) 84

    Abstract: Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community-acquired pneumonia. Observations shortly after the start of the COVID-19 ... ...

    Abstract Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community-acquired pneumonia. Observations shortly after the start of the COVID-19 pandemic in 2020 suggested that ibuprofen was associated with an increased risk of adverse events in COVID-19 patients, but subsequent observational studies failed to demonstrate increased risk and in one case showed reduced risk associated with NSAID use.
    Methods: A 38-center retrospective cohort study was performed that leveraged the harmonized, high-granularity electronic health record data of the National COVID Cohort Collaborative. A propensity-matched cohort of 19,746 COVID-19 inpatients was constructed by matching cases (treated with NSAIDs at the time of admission) and 19,746 controls (not treated) from 857,061 patients with COVID-19 available for analysis. The primary outcome of interest was COVID-19 severity in hospitalized patients, which was classified as: moderate, severe, or mortality/hospice. Secondary outcomes were acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO), invasive ventilation, and all-cause mortality at any time following COVID-19 diagnosis.
    Results: Logistic regression showed that NSAID use was not associated with increased COVID-19 severity (OR: 0.57 95% CI: 0.53-0.61). Analysis of secondary outcomes using logistic regression showed that NSAID use was not associated with increased risk of all-cause mortality (OR 0.51 95% CI: 0.47-0.56), invasive ventilation (OR: 0.59 95% CI: 0.55-0.64), AKI (OR: 0.67 95% CI: 0.63-0.72), or ECMO (OR: 0.51 95% CI: 0.36-0.7). In contrast, the odds ratios indicate reduced risk of these outcomes, but our quantitative bias analysis showed E-values of between 1.9 and 3.3 for these associations, indicating that comparatively weak or moderate confounder associations could explain away the observed associations.
    Conclusions: Study interpretation is limited by the observational design. Recording of NSAID use may have been incomplete. Our study demonstrates that NSAID use is not associated with increased COVID-19 severity, all-cause mortality, invasive ventilation, AKI, or ECMO in COVID-19 inpatients. A conservative interpretation in light of the quantitative bias analysis is that there is no evidence that NSAID use is associated with risk of increased severity or the other measured outcomes. Our results confirm and extend analogous findings in previous observational studies using a large cohort of patients drawn from 38 centers in a nationally representative multicenter database.
    MeSH term(s) Acute Kidney Injury ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; COVID-19 ; COVID-19 Testing ; Cohort Studies ; Humans ; Pandemics ; Retrospective Studies
    Chemical Substances Anti-Inflammatory Agents, Non-Steroidal
    Language English
    Publishing date 2022-05-15
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2160640-7
    ISSN 1743-422X ; 1743-422X
    ISSN (online) 1743-422X
    ISSN 1743-422X
    DOI 10.1186/s12985-022-01813-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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