tetano
Editor, Senior Moderator
Sci Rep
. 2020 Nov 20;10(1):20250.
doi: 10.1038/s41598-020-76915-4.
Adverse impact of renin-angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study
Jeong-Hoon Lim[SUP] 1 [/SUP], Jang-Hee Cho[SUP] 1 [/SUP], Yena Jeon[SUP] 2 [/SUP], Ji Hye Kim[SUP] 1 [/SUP], Ga Young Lee[SUP] 1 [/SUP], Soojee Jeon[SUP] 1 [/SUP], Hee Won Noh[SUP] 1 [/SUP], Yong-Hoon Lee[SUP] 3 [/SUP], Jaehee Lee[SUP] 3 [/SUP], Hyun-Ha Chang[SUP] 4 [/SUP], Hee-Yeon Jung[SUP] 1 [/SUP], Ji-Young Choi[SUP] 1 [/SUP], Sun-Hee Park[SUP] 1 [/SUP], Chan-Duck Kim[SUP] 1 [/SUP], Yong-Lim Kim[SUP] 1 [/SUP], Shin-Woo Kim[SUP] 5 [/SUP]
Affiliations
Abstract
The association between angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) and the risk of mortality in hospitalized patients with severe coronavirus disease 2019 (COVID-19) was investigated. This retrospective cohort study was performed in all hospitalized patients with COVID-19 in tertiary hospitals in Daegu, Korea. Patients were classified based on whether they received ACE-I or ARB before COVID-19 diagnosis. The analysis of the primary outcome, in-hospital mortality, was performed using the Cox proportional hazards regression model. Of 130 patients with COVID-19, 30 (23.1%) who received ACE-I or ARB exhibited an increased risk of in-hospital mortality (adjusted hazard ratio, 2.20; 95% confidence interval [CI], 1.10-4.38; P = 0.025). ACE-I or ARB was also associated with severe complications, such as acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR], 2.58; 95% CI, 1.02-6.51; P = 0.045) and acute kidney injury (AKI) (aOR, 3.06; 95% CI, 1.15-8.15; P = 0.026). Among the patients with ACE-I or ARB therapy, 8 patients (26.7%) used high equivalent doses of ACE-I or ARB and they had higher in-hospital mortality and an increased risk of ARDS and AKI (all, P < 0.05). ACE-I or ARB therapy in patients with severe COVID-19 was associated with the occurrence of severe complications and increased in-hospital mortality. The potentially harmful effect of ACE-I or ARB therapy may be higher in patients who received high doses.
. 2020 Nov 20;10(1):20250.
doi: 10.1038/s41598-020-76915-4.
Adverse impact of renin-angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study
Jeong-Hoon Lim[SUP] 1 [/SUP], Jang-Hee Cho[SUP] 1 [/SUP], Yena Jeon[SUP] 2 [/SUP], Ji Hye Kim[SUP] 1 [/SUP], Ga Young Lee[SUP] 1 [/SUP], Soojee Jeon[SUP] 1 [/SUP], Hee Won Noh[SUP] 1 [/SUP], Yong-Hoon Lee[SUP] 3 [/SUP], Jaehee Lee[SUP] 3 [/SUP], Hyun-Ha Chang[SUP] 4 [/SUP], Hee-Yeon Jung[SUP] 1 [/SUP], Ji-Young Choi[SUP] 1 [/SUP], Sun-Hee Park[SUP] 1 [/SUP], Chan-Duck Kim[SUP] 1 [/SUP], Yong-Lim Kim[SUP] 1 [/SUP], Shin-Woo Kim[SUP] 5 [/SUP]
Affiliations
- PMID: 33219294
- DOI: 10.1038/s41598-020-76915-4
Abstract
The association between angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) and the risk of mortality in hospitalized patients with severe coronavirus disease 2019 (COVID-19) was investigated. This retrospective cohort study was performed in all hospitalized patients with COVID-19 in tertiary hospitals in Daegu, Korea. Patients were classified based on whether they received ACE-I or ARB before COVID-19 diagnosis. The analysis of the primary outcome, in-hospital mortality, was performed using the Cox proportional hazards regression model. Of 130 patients with COVID-19, 30 (23.1%) who received ACE-I or ARB exhibited an increased risk of in-hospital mortality (adjusted hazard ratio, 2.20; 95% confidence interval [CI], 1.10-4.38; P = 0.025). ACE-I or ARB was also associated with severe complications, such as acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR], 2.58; 95% CI, 1.02-6.51; P = 0.045) and acute kidney injury (AKI) (aOR, 3.06; 95% CI, 1.15-8.15; P = 0.026). Among the patients with ACE-I or ARB therapy, 8 patients (26.7%) used high equivalent doses of ACE-I or ARB and they had higher in-hospital mortality and an increased risk of ARDS and AKI (all, P < 0.05). ACE-I or ARB therapy in patients with severe COVID-19 was associated with the occurrence of severe complications and increased in-hospital mortality. The potentially harmful effect of ACE-I or ARB therapy may be higher in patients who received high doses.