Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review
Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, a large number of critically ill and severe COVID-19 patients meet the diagnostic criteria for sepsis and even septic shock. The treatments for COVID-19 patients with sepsis are still very limited. For sepsis, improving ventilati...
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2023.1172447/full |
| _version_ | 1797349414791020544 |
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| author | Ying Wang Ying Wang Qian Yu Yuan Tian Shiying Ren Liping Liu Chaojie Wei Renli Liu Jing Wang Dong Li Kun Zhu |
| author_facet | Ying Wang Ying Wang Qian Yu Yuan Tian Shiying Ren Liping Liu Chaojie Wei Renli Liu Jing Wang Dong Li Kun Zhu |
| author_sort | Ying Wang |
| collection | DOAJ |
| description | Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, a large number of critically ill and severe COVID-19 patients meet the diagnostic criteria for sepsis and even septic shock. The treatments for COVID-19 patients with sepsis are still very limited. For sepsis, improving ventilation is one of the main treatments. Nitric oxide (NO) and almitrine have been reported to improve oxygenation in patients with “classical” sepsis. Here, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of NO, almitrine, and the combination of both for COVID-19 (at the edge of sepsis) patients.Method: A systematic search was performed on Embase, PubMed, the Cochrane Library, the Web of Science, Wanfang Data, and China National Knowledge Infrastructure. Randomized clinical trials, cohort studies, cross-sectional studies, case-control studies, case series, and case reports in COVID-19 patients with suspected or confirmed sepsis were performed. Study characteristics, patient demographics, interventions, and outcomes were extracted from eligible articles.Results: A total of 35 studies representing 1,701 patients met eligibility criteria. Inhaled NO did not affect the mortality (OR 0.96, 95% CI 0.33–2.8, I2 = 81%, very low certainty), hospital length of stay (SMD 0.62, 95% CI 0.04–1.17, I2 = 83%, very low certainty), and intubation needs (OR 0.82, 95% CI 0.34–1.93, I2 = 56%, very low certainty) of patients with COVID-19 (at the edge of sepsis). Meanwhile, almitrine did not affect the mortality (OR 0.44, 95% CI 0.17–1.13, low certainty), hospital length of stay (SMD 0.00, 95% CI -0.29–0.29, low certainty), intubation needs (OR 0.94, 95% CI 0.5–1.79, low certainty), and SAEs (OR 1.16, 95% CI 0.63–2.15, low certainty). Compared with pre-administration, the PaO2/FiO2 of patients with NO (SMD-0.87, 95% CI -1.08–0.66, I2 = 0%, very low certainty), almitrine (SMD-0.73, 95% CI-1.06–0.4, I2 = 1%, very low certainty), and the combination of both (SMD-0.94, 95% CI-1.71–0.16, I2 = 47%, very low certainty) increased significantly.Conclusion: Inhaled NO, almitrine, and the combination of the two drugs improved oxygenation significantly, but did not affect the patients’ mortality, hospitalization duration, and intubation needs. Almitrine did not significantly increase the patients’ SAEs. Well-designed high-quality studies are needed for establishing a stronger quality of evidence.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=367667, identifier CRD42022367667. |
| first_indexed | 2024-03-08T12:29:55Z |
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| language | English |
| last_indexed | 2024-03-08T12:29:55Z |
| publishDate | 2024-01-01 |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-253ba672164a4b7e8fb0c91b496340f62024-01-22T04:30:22ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122024-01-011410.3389/fphar.2023.11724471172447Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic reviewYing Wang0Ying Wang1Qian Yu2Yuan Tian3Shiying Ren4Liping Liu5Chaojie Wei6Renli Liu7Jing Wang8Dong Li9Kun Zhu10Department of Pharmacy, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, ChinaDepartment of Immunology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin, ChinaDepartment of Pharmacy, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, Jilin University, Changchun, Jilin, ChinaDepartment of Immunology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin, ChinaDepartment of Immunology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin, ChinaDepartment of Immunology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin, ChinaDepartment of Immunology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin, ChinaDepartment of Pharmacy, Siping Tumor Hospital, Siping, Jilin, ChinaDepartment of Immunology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin, ChinaDepartment of Pharmacy, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, ChinaIntroduction: During the coronavirus disease 2019 (COVID-19) pandemic, a large number of critically ill and severe COVID-19 patients meet the diagnostic criteria for sepsis and even septic shock. The treatments for COVID-19 patients with sepsis are still very limited. For sepsis, improving ventilation is one of the main treatments. Nitric oxide (NO) and almitrine have been reported to improve oxygenation in patients with “classical” sepsis. Here, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of NO, almitrine, and the combination of both for COVID-19 (at the edge of sepsis) patients.Method: A systematic search was performed on Embase, PubMed, the Cochrane Library, the Web of Science, Wanfang Data, and China National Knowledge Infrastructure. Randomized clinical trials, cohort studies, cross-sectional studies, case-control studies, case series, and case reports in COVID-19 patients with suspected or confirmed sepsis were performed. Study characteristics, patient demographics, interventions, and outcomes were extracted from eligible articles.Results: A total of 35 studies representing 1,701 patients met eligibility criteria. Inhaled NO did not affect the mortality (OR 0.96, 95% CI 0.33–2.8, I2 = 81%, very low certainty), hospital length of stay (SMD 0.62, 95% CI 0.04–1.17, I2 = 83%, very low certainty), and intubation needs (OR 0.82, 95% CI 0.34–1.93, I2 = 56%, very low certainty) of patients with COVID-19 (at the edge of sepsis). Meanwhile, almitrine did not affect the mortality (OR 0.44, 95% CI 0.17–1.13, low certainty), hospital length of stay (SMD 0.00, 95% CI -0.29–0.29, low certainty), intubation needs (OR 0.94, 95% CI 0.5–1.79, low certainty), and SAEs (OR 1.16, 95% CI 0.63–2.15, low certainty). Compared with pre-administration, the PaO2/FiO2 of patients with NO (SMD-0.87, 95% CI -1.08–0.66, I2 = 0%, very low certainty), almitrine (SMD-0.73, 95% CI-1.06–0.4, I2 = 1%, very low certainty), and the combination of both (SMD-0.94, 95% CI-1.71–0.16, I2 = 47%, very low certainty) increased significantly.Conclusion: Inhaled NO, almitrine, and the combination of the two drugs improved oxygenation significantly, but did not affect the patients’ mortality, hospitalization duration, and intubation needs. Almitrine did not significantly increase the patients’ SAEs. Well-designed high-quality studies are needed for establishing a stronger quality of evidence.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=367667, identifier CRD42022367667.https://www.frontiersin.org/articles/10.3389/fphar.2023.1172447/fullsevere acute respiratory syndrome coronavirus 2coronavirus disease 2019sepsisinhaled nitric oxidealmitrine |
| spellingShingle | Ying Wang Ying Wang Qian Yu Yuan Tian Shiying Ren Liping Liu Chaojie Wei Renli Liu Jing Wang Dong Li Kun Zhu Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review Frontiers in Pharmacology severe acute respiratory syndrome coronavirus 2 coronavirus disease 2019 sepsis inhaled nitric oxide almitrine |
| title | Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review |
| title_full | Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review |
| title_fullStr | Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review |
| title_full_unstemmed | Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review |
| title_short | Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review |
| title_sort | unraveling the impact of nitric oxide almitrine and their combination in covid 19 at the edge of sepsis patients a systematic review |
| topic | severe acute respiratory syndrome coronavirus 2 coronavirus disease 2019 sepsis inhaled nitric oxide almitrine |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2023.1172447/full |
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