tetano
Editor, Senior Moderator
J Am Med Dir Assoc
. 2020 Nov;21(11):1539-1545.
doi: 10.1016/j.jamda.2020.09.004. Epub 2020 Sep 9.
COVID-19 In-Hospital Mortality and Use of Renin-Angiotensin System Blockers in Geriatrics Patients
Bastien Genet[SUP] 1 [/SUP], Jean-S?bastien Vidal[SUP] 2 [/SUP], Adrien Cohen[SUP] 2 [/SUP], Cl?mence Boully[SUP] 2 [/SUP], Ma?lle Beunardeau[SUP] 2 [/SUP], Louise Marine Harl?[SUP] 2 [/SUP], Anna Gon?alves[SUP] 2 [/SUP], Yasmina Boudali[SUP] 2 [/SUP], Intza Hernandorena[SUP] 2 [/SUP], Henri Bailly[SUP] 2 [/SUP], Hermine Lenoir[SUP] 2 [/SUP], Matthieu Piccoli[SUP] 2 [/SUP], Anne Chahwakilian[SUP] 2 [/SUP], L?na Kermanach[SUP] 2 [/SUP], Laura de Jong[SUP] 3 [/SUP], Emmanuelle Duron[SUP] 4 [/SUP], Xavier Girerd[SUP] 5 [/SUP], Olivier Hanon[SUP] 6 [/SUP]
Affiliations
Abstract
Objective: The role of treatment with renin-angiotensin-aldosterone system blockers at the onset of COVID-19 infection is not known in the geriatric population. The aim of this study was to assess the relationship between angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitor (ACEI) use and in-hospital mortality in geriatric patients hospitalized for COVID-19.
Design: This observational retrospective study was conducted in a French geriatric department. Patients were included between March 17 and April 18, 2020.
Setting and participants: All consecutive 201 patients hospitalized for COVID-19 (confirmed by reverse-transcriptase polymerase chain reaction methods) were included. All nondeceased patients had 30 days of follow-up and no patient was lost to follow-up.
Methods: Demographic, clinical, and biological data and medications were collected. In-hospital mortality of patients treated or not by ACEI/ARB was analyzed using multivariate Cox models.
Results: Mean age of the population was 86.3 (8.0) years, 62.7% of patients were institutionalized, 88.6% had dementia, and 53.5% had severe disability (activities of daily living [ADL] score <2). Sixty-three patients were treated with ACEI/ARB and 138 were not. Mean follow-up was 23.4 (10.0) days, 66 (33.8%) patients died after an average of 10.0 days (6.0). Lower mortality rate was observed in patients treated with ACEI/ARB compared with patients not treated with ARB or ACEI (22.2% [14] vs 37.7% [52], hazard ratio
0.54; 95% confidence interval 0.30-0.97; P = .03). In a multivariate Cox regression model including age, sex, ADL score, Charlson index, renal function, dyspnea, C-reactive protein, and white blood cell count, use of ACEI/ARB was significantly associated with lower in-hospital mortality (HR 0.52 (0.27-0.99), P = .048).
Conclusion and implications: In very old subjects hospitalized in geriatric settings for COVID-19, mortality was significantly lower in subjects treated with ARB or ACEI before the onset of infection. The continuation of ACEI/ARB therapy should be encouraged during periods of coronavirus outbreak in older subjects.
Keywords: COVID-19; angiotensin receptor blockers; angiotensin-converting enzyme inhibitor; geriatrics; in-hospital mortality; renin-angiotensin-aldosterone system blockers.
. 2020 Nov;21(11):1539-1545.
doi: 10.1016/j.jamda.2020.09.004. Epub 2020 Sep 9.
COVID-19 In-Hospital Mortality and Use of Renin-Angiotensin System Blockers in Geriatrics Patients
Bastien Genet[SUP] 1 [/SUP], Jean-S?bastien Vidal[SUP] 2 [/SUP], Adrien Cohen[SUP] 2 [/SUP], Cl?mence Boully[SUP] 2 [/SUP], Ma?lle Beunardeau[SUP] 2 [/SUP], Louise Marine Harl?[SUP] 2 [/SUP], Anna Gon?alves[SUP] 2 [/SUP], Yasmina Boudali[SUP] 2 [/SUP], Intza Hernandorena[SUP] 2 [/SUP], Henri Bailly[SUP] 2 [/SUP], Hermine Lenoir[SUP] 2 [/SUP], Matthieu Piccoli[SUP] 2 [/SUP], Anne Chahwakilian[SUP] 2 [/SUP], L?na Kermanach[SUP] 2 [/SUP], Laura de Jong[SUP] 3 [/SUP], Emmanuelle Duron[SUP] 4 [/SUP], Xavier Girerd[SUP] 5 [/SUP], Olivier Hanon[SUP] 6 [/SUP]
Affiliations
- PMID: 33138935
- DOI: 10.1016/j.jamda.2020.09.004
Abstract
Objective: The role of treatment with renin-angiotensin-aldosterone system blockers at the onset of COVID-19 infection is not known in the geriatric population. The aim of this study was to assess the relationship between angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitor (ACEI) use and in-hospital mortality in geriatric patients hospitalized for COVID-19.
Design: This observational retrospective study was conducted in a French geriatric department. Patients were included between March 17 and April 18, 2020.
Setting and participants: All consecutive 201 patients hospitalized for COVID-19 (confirmed by reverse-transcriptase polymerase chain reaction methods) were included. All nondeceased patients had 30 days of follow-up and no patient was lost to follow-up.
Methods: Demographic, clinical, and biological data and medications were collected. In-hospital mortality of patients treated or not by ACEI/ARB was analyzed using multivariate Cox models.
Results: Mean age of the population was 86.3 (8.0) years, 62.7% of patients were institutionalized, 88.6% had dementia, and 53.5% had severe disability (activities of daily living [ADL] score <2). Sixty-three patients were treated with ACEI/ARB and 138 were not. Mean follow-up was 23.4 (10.0) days, 66 (33.8%) patients died after an average of 10.0 days (6.0). Lower mortality rate was observed in patients treated with ACEI/ARB compared with patients not treated with ARB or ACEI (22.2% [14] vs 37.7% [52], hazard ratio
0.54; 95% confidence interval 0.30-0.97; P = .03). In a multivariate Cox regression model including age, sex, ADL score, Charlson index, renal function, dyspnea, C-reactive protein, and white blood cell count, use of ACEI/ARB was significantly associated with lower in-hospital mortality (HR 0.52 (0.27-0.99), P = .048).
Conclusion and implications: In very old subjects hospitalized in geriatric settings for COVID-19, mortality was significantly lower in subjects treated with ARB or ACEI before the onset of infection. The continuation of ACEI/ARB therapy should be encouraged during periods of coronavirus outbreak in older subjects.
Keywords: COVID-19; angiotensin receptor blockers; angiotensin-converting enzyme inhibitor; geriatrics; in-hospital mortality; renin-angiotensin-aldosterone system blockers.