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.
【저자키워드】 viral infection, Risk factors, 【초록키워드】 COVID-19, ARDS, therapy, Mortality, severe COVID-19, hospital, risk, Acute kidney injury, ARB, AKI, Regression model, Patient, COVID-19 diagnosis, receptor, in-hospital mortality, association, acute respiratory distress, angiotensin-converting enzyme inhibitor, Analysis, dose, retrospective cohort study, adjusted odds ratio, Primary outcome, 95% CI, 95% confidence interval, adjusted hazard ratio, increased risk, severe coronavirus disease, syndrome, severe complications, doses, Occurrence, the patient, investigated, was performed, exhibited, hospitalized patient, severe complication, Cox proportional hazard, patients with COVID-19, with COVID-19, 【제목키워드】 Clinical course, retrospective cohort study, Adverse, blockade, hospitalized patient,