Adverse impact of renin-angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study.

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.

• Authors: Jeong-Hoon Lim, Jang-Hee Cho, Yena Jeon, Ji Hye Kim, Ga Young Lee, Soojee Jeon, Hee Won Noh, Yong-Hoon Lee, Jaehee Lee, Hyun-Ha Chang, Hee-Yeon Jung, Ji-Young Choi, Sun-Hee Park, Chan-Duck Kim, Yong-Lim Kim, Shin-Woo Kim
• Journal: Scientific reports (Sci Rep) Vol. 10 Issue 1 Pg. 20250 (11 20 2020) ISSN: 2045-2322 [Electronic] England
• PMID: 33219294 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors

Topics

• Aged
• Angiotensin Receptor Antagonists (adverse effects, therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (adverse effects, therapeutic use)
• COVID-19 (epidemiology, virology)
• Female
• Hospital Mortality
• Host-Pathogen Interactions (drug effects)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Pandemics
• Renin-Angiotensin System (drug effects)
• Republic of Korea
• Retrospective Studies
• SARS-CoV-2 (drug effects, physiology)
• Severity of Illness Index
• Tertiary Care Centers
• COVID-19 Drug Treatment