tetano
Editor, Senior Moderator
J Med Virol
. 2020 Nov 24.
doi: 10.1002/jmv.26695. Online ahead of print.
Effects of Renin-Angiotensin-Aldosterone System (RAAS) Inhibitors on Disease Severity and Mortality in Patients with COVID-19: A Meta-analysis
Guoyue Zhang[SUP] 1 [/SUP], Yue Wu[SUP] 1 [/SUP], Rui Xu[SUP] 1 [/SUP], Xianzhi Du[SUP] 1 [/SUP]
Affiliations
Abstract
Objective: To investigate the effects of renin-angiotensin-aldosterone system (RAAS) inhibitors on the prognosis in patients with coronavirus disease 2019 (COVID-19).
Methods: A meta-analysis was performed. We systematically searched PubMed, the Cochrane Library, the Web of Science, EMBASE, medRxiv and bioRxiv database through October 30, 2020. The primary and secondary outcomes were mortality and severe COVID-19, respectively.
Results: We included 25 studies with 22,734 COVID-19 patients, and we compared the outcomes between patients who did and did not receive ACEIs/ARBs. The use of ACEIs/ARBs was not associated with higher risks of severe disease (OR = 0.89, 95% CI: 0.63, 1.15, I2=38.55%), mechanical ventilation (OR = 0.89, 95% CI: 0.61, 1.16, I2=3.19%), dialysis (OR = 1.24, 95% CI: 0.09, 2.39, I2=0.00%), or the length of hospital stay (SMD = 0.05, 95% CI: -0.16, 0.26, I2=84.43%) in COVID-19 patients. The effect estimates showed an overall protective effect of ACEIs/ARBs against mortality (OR = 0.65, 95% CI: 0.46, 0.85, I2= 73.37%), severity/mortality (OR = 0.69, 95% CI: 0.43, 0.95, I2=22.90%), transfer to the intensive care unit (ICU) among COVID-19 patients with hypertension (OR = 0.36, 95% CI: 0.19, 0.53, I2=0.00%), hospitalization (OR = 0.79, 95% CI: 0.60, 0.98, I2=0.00%) and acute respiratory distress syndrome (ARDS) (OR = 0.71, 95% CI: 0.46, 0.95, I2=0.00%).
Conclusion: The use of renin-angiotensin-aldosterone system (RAAS) inhibitor was not associated with increased mortality or disease severity in COVID-19 patients. This study supports the current guidelines that discourage the discontinuation of RAAS inhibitors in COVID-19 patients. This article is protected by copyright. All rights reserved.
Keywords: angiotensin receptor blockers (ARBs); angiotensin-converting enzyme inhibitors (ACEIs); coronavirus disease 2019 (COVID-19); meta-analysis; mortality; severity.
. 2020 Nov 24.
doi: 10.1002/jmv.26695. Online ahead of print.
Effects of Renin-Angiotensin-Aldosterone System (RAAS) Inhibitors on Disease Severity and Mortality in Patients with COVID-19: A Meta-analysis
Guoyue Zhang[SUP] 1 [/SUP], Yue Wu[SUP] 1 [/SUP], Rui Xu[SUP] 1 [/SUP], Xianzhi Du[SUP] 1 [/SUP]
Affiliations
- PMID: 33231299
- DOI: 10.1002/jmv.26695
Abstract
Objective: To investigate the effects of renin-angiotensin-aldosterone system (RAAS) inhibitors on the prognosis in patients with coronavirus disease 2019 (COVID-19).
Methods: A meta-analysis was performed. We systematically searched PubMed, the Cochrane Library, the Web of Science, EMBASE, medRxiv and bioRxiv database through October 30, 2020. The primary and secondary outcomes were mortality and severe COVID-19, respectively.
Results: We included 25 studies with 22,734 COVID-19 patients, and we compared the outcomes between patients who did and did not receive ACEIs/ARBs. The use of ACEIs/ARBs was not associated with higher risks of severe disease (OR = 0.89, 95% CI: 0.63, 1.15, I2=38.55%), mechanical ventilation (OR = 0.89, 95% CI: 0.61, 1.16, I2=3.19%), dialysis (OR = 1.24, 95% CI: 0.09, 2.39, I2=0.00%), or the length of hospital stay (SMD = 0.05, 95% CI: -0.16, 0.26, I2=84.43%) in COVID-19 patients. The effect estimates showed an overall protective effect of ACEIs/ARBs against mortality (OR = 0.65, 95% CI: 0.46, 0.85, I2= 73.37%), severity/mortality (OR = 0.69, 95% CI: 0.43, 0.95, I2=22.90%), transfer to the intensive care unit (ICU) among COVID-19 patients with hypertension (OR = 0.36, 95% CI: 0.19, 0.53, I2=0.00%), hospitalization (OR = 0.79, 95% CI: 0.60, 0.98, I2=0.00%) and acute respiratory distress syndrome (ARDS) (OR = 0.71, 95% CI: 0.46, 0.95, I2=0.00%).
Conclusion: The use of renin-angiotensin-aldosterone system (RAAS) inhibitor was not associated with increased mortality or disease severity in COVID-19 patients. This study supports the current guidelines that discourage the discontinuation of RAAS inhibitors in COVID-19 patients. This article is protected by copyright. All rights reserved.
Keywords: angiotensin receptor blockers (ARBs); angiotensin-converting enzyme inhibitors (ACEIs); coronavirus disease 2019 (COVID-19); meta-analysis; mortality; severity.