Non-steroidal anti-inflammatory drug use and clinical outcomes of community-acquired pneumonia

Abstract

Objective: Non-steroidal anti-inflammatory drugs (NSAID) may decrease immunity and attenuate symptoms of infection. We examined whether pre-admission use of NSAID was associated with complications of community-acquired pneumonia (CAP). Methods: We conducted a population-based cohort study including all adults hospitalized for CAP between 1997 and 2011 in Northern Denmark. Information on comorbidities, medications, complications, and death was obtained from medical databases. We computed adjusted rate ratios (aRR) of pleuropulmonary complications (pleural empyema, lung abscess) and adjusted 30-day mortality rate ratios (aMRR) associated with exposure to NSAID use at the time of admission with CAP (current use) or more than 60 days before (former use). We used regression analyses to adjust for confounders, and applied sensitivity analyses with different NSAID exposure windows to counteract possible protopathic bias. Results: Of 59,250 patients with CAP, 9,012 (15.2%) were current NSAID users and another 9,690 (16.4%) were former users. Current users were at higher risk of pleuropulmonary complications (3.8%) compared to former users (2.4%) and non-users (2.3%). The aRR of pleuropulmonary complications was highly increased in current NSAID users (aRR = 1.81 [95% CI: 1.60 – 2.05]), most so among young patients (18-44 years; aRR = 3.48 [95% CI: 2.64 – 4.60]) and in patients without comorbidities (aRR = 2.29 [95% CI: 1.94 – 2.70]). Results remained robust in several sensitivity analyses. NSAID intake was not associated with 30-day mortality: aMRR = 1.01 [95% CI: 0.96 – 1.07]. Conclusion: Current NSAID use is a risk factor for pleuropulmonary complications among hospitalized patients with CAP.