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 first cohort consisted of patients identified with International Classification of Diseases (ICD)-9 code 518.82 (which encompasses acute respiratory failure including ARDS). Of the 13,125 men in this cohort, we found 655 patients (5.0%) with prior use of ⍺1-AR antagonists. Overall, 15.9% of all patients received invasive mechanical ventilation and 8.2% both were ventilated and died in the hospital. We found that patients with prior use of ⍺1-AR antagonists had ~22% lower incidence of invasive mechanical ventilation compared to non-users (OR=0.75, 95% CI 0.59-0.94, p=0.015; AOR=0.75, 95% CI 0.59-0.95, p=0.019) (Figure 1 B,C) . Perhaps more importantly, those patients had a ~36% lower incidence of both being ventilated and dying in the hospital (OR=0.63, 95% CI 0.37-1.01, p=0.074; AOR=0.59, 95% CI 0.34-0.95, p=0.042) (Figure 1 B,D) . By contrast, prior use of beta-adrenergic receptor (β-AR) antagonists was not correlated with either outcome in this cohort (Figure 1 C,D) .