Targeting the catecholamine-cytokine axis to prevent SARS-CoV-2 cytokine storm syndrome

Maximilian F Konig; Mike Powell; Verena Staedtke; Ren-Yuan Bai; David L Thomas; Nicole Fischer; Sakibul Huq; Adham M Khalafallah; Allison Koenecke; Nickolas Papadopoulos; Kenneth W Kinzler; Bert Vogelstein; Joshua T Vogelstein; Susan Athey; Shibin Zhou; Chetan Bettegowda

The second cohort consisted of patients admitted with pneumonia, identified by the Agency for Healthcare Research and Quality's (AHRQ) pneumonia category, which comprises a number of codes from the ICD-9 and ICD-10, respectively. Of the 108,956 subjects in this cohort, 5,498 patients (5.0%) were taking ⍺1-AR antagonist. Overall, 8.9% of all patients received invasive mechanical ventilation and 2.1% both were ventilated and died in the hospital. We found that patients with prior use of ⍺1-AR antagonists had ~13% lower incidence of invasive mechanical ventilation compared to non-users (OR=0.86, 95% CI 0.78-0.95, p=0.004; AOR=0.83, 95% CI 0.75-0.92, p<0.001) (Figure 1 E,F) . Further, those patients had a ~16% lower incidence of both being ventilated and dying in the hospital (OR=0.84, 95% CI 0.68-1.02, p=0.087; AOR=0.77, 95% CI 0.62-0.94, p=0.014) (Figure 1 E,G) . By contrast, prior use of β-AR antagonists was not correlated with either outcome in this cohort, with or without adjusting (Figure 1 F,G) .