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Musculoskeletal Disorders, Pain Medication, and in-Hospital Mortality among Patients with COVID-19 in South Korea: A
Tak-Kyu Oh1, In-Ae Song1, Joon Lee2
1Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
Insights
Musculoskeletal disorders (MSDs) did not increase COVID-19 mortality. However, strong opioid use significantly raised in-hospital mortality risk in patients with coronavirus disease 2019 (COVID-19).
Area of Science:
- Medical Research
- Epidemiology
- Pharmacology
Background:
- Comorbidities and medication use are critical factors in patient outcomes.
- Understanding the impact of musculoskeletal disorders (MSDs) and pain relievers on COVID-19 mortality is essential for clinical management.
Purpose of the Study:
- To investigate the association between comorbid MSDs and pain medication use with in-hospital mortality in COVID-19 patients.
- To identify specific pain medications that may influence mortality risk in coronavirus disease 2019 (COVID-19) patients.
Main Methods:
- Retrospective cohort study using the South Korean National Health Insurance COVID-19 database.
- Inclusion criteria: adult patients (≥20 years) with a positive COVID-19 diagnosis until June 5, 2020.
- Analysis of in-hospital mortality in relation to MSDs and various pain medications, including strong opioids, using multivariate logistic regression.
Main Results:
- No significant association was found between MSDs and in-hospital mortality in COVID-19 patients.
- Strong opioid use was significantly associated with a 12.73-fold increase in in-hospital mortality (OR: 12.73, 95% CI: 2.44-16.64, p=0.002).
- Use of paracetamol, gabapentin, pregabalin, glucocorticoids, NSAIDs, weak opioids, and benzodiazepines showed no significant association with mortality.
Conclusions:
- Underlying musculoskeletal disorders do not appear to increase in-hospital mortality risk for patients with COVID-19.
- Strong opioid use is a significant risk factor for increased in-hospital mortality among coronavirus disease 2019 (COVID-19) patients.
- Clinical guidelines should consider the risks associated with strong opioid use in COVID-19 management.
Abstract:
We aimed to investigate whether comorbid musculoskeletal disorders (MSD)s and pain medication use was associated with in-hospital mortality among patients with coronavirus disease 2019 (COVID-19). Adult patients (≥20 years old) with a positive COVID-19 diagnosis until 5 June 2020 were included in this study, based on the National Health Insurance COVID-19 database in South Korea. MSDs included osteoarthritis, neck pain, lower back pain, rheumatoid arthritis, and others, while pain medication included paracetamol, gabapentin, pregabalin, glucocorticoid, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids (strong and weak opioids), and benzodiazepine. Primary endpoint was in-hospital mortality. A total of 7713 patients with COVID-19 were included, and in-hospital mortality was observed in 248 (3.2%) patients. In multivariate logistic regression analysis, no MSDs (p > 0.05) were significantly associated with in-hospital mortality. However, in-hospital mortality was 12.73 times higher in users of strong opioids (odds ratio: 12.73, 95% confidence interval: 2.44-16.64; p = 0.002), while use of paracetamol (p = 0.973), gabapentin or pregabalin (p = 0.424), glucocorticoid (p = 0.673), NSAIDs (p = 0.979), weak opioids (p = 0.876), and benzodiazepine (p = 0.324) was not associated with in-hospital mortality. In South Korea, underlying MSDs were not associated with increased in-hospital mortality among patients with COVID-19. However, use of strong opioids was significantly associated with increased in-hospital mortality among the patients.
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