Abstract
Background: The influence of renin-angiotensin-aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients.
Methods: Data from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included. A cohort of 737 COVID-19 patients with pre-existing hypertension admitted to intensive care units (ICUs) in 2020 were targeted. Multi-state survival analysis was performed to evaluate in-hospital mortality and hospital length of stay up to 90 days following ICU admission.
Results: A total of 737 patients were included-538 (73%) with pre-existing hypertension had received ACEi/ARBs before ICU admission, while 199 (27%) had not. Cox proportional hazards model showed that previous ACEi/ARB use was associated with a decreased hazard of in-hospital death (HR, 0.74, 95% CI 0.58-0.94). Sensitivity analysis adjusted for propensity scores showed similar results for hazards of death. The average length of hospital stay was longer in ACEi/ARB group with 21.2 days (95% CI 19.7-22.8 days) in ICU and 6.7 days (5.9-7.6 days) in general ward compared to non-ACEi/ARB group with 16.2 days (14.1-18.6 days) and 6.4 days (5.1-7.9 days), respectively. When analysed separately, results for ACEi or ARB patient groups were similar for both death and discharge.
Conclusions: In critically ill COVID-19 patients with comorbid hypertension, use of ACEi/ARBs prior to ICU admission was associated with a reduced risk of in-hospital mortality following adjustment for baseline characteristics although patients with ACEi/ARB showed longer length of hospital stay. Clinical trial registration The registration number: ACTRN12620000421932; The date of registration: 30, March 2020; The URL of the registration: https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12620000421932 .
Keywords: Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; COVID-19; Critical care; Severe acute respiratory syndrome coronavirus 2.
【저자키워드】 COVID-19, severe acute respiratory syndrome coronavirus 2, Critical care, Angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, 【초록키워드】 coronavirus, hospital, intensive care unit, hypertension, discharge, ICU, ARB, Cohort, survival, Critically ill, clinical, International, Patient, ICU admission, death, RAAS, receptor, inhibitor, in-hospital mortality, COVID-19 patients, angiotensin receptor blocker, angiotensin-converting enzyme inhibitor, Analysis, angiotensin, COVID-19 patient, Hospital stay, In-hospital death, Observational cohort study, acute respiratory syndrome, Trial registration, 95% CI, baseline characteristics, reduced risk, enzyme, average, hazard, ICUs, ACEi/ARB, country, evaluate, examined, patient group, was performed, analysed, adjusted, Cox proportional hazard, remains uncertain, 【제목키워드】 Mortality, prospective cohort study, Critically ill, Impact, COVID-19 patient,