Background: and Aims; To investigate the association between use of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin-receptor blocker (ARB) and outcomes of hypertensive COVID-19 patients, a systematic review and meta-analysis were performed. Methods: We systematically searched PubMed, EuropePMC, ProQuest, and Cochrane Central Databases using the terms "(COVID-19 OR SARS-CoV-2) AND (angiotensin converting enzyme OR angiotensin receptor blocker)". The primary and second outcomes were mortality (non-survivor) and severe COVID-19, respectively. Results: Totally, 7410 patients were included from 15 studies. Pooled analysis showed that the use of ACEI/ARB was not associated with mortality (OR 0.73 [0.38, 1.40], p ¼ 0.34; I 2 : 81%) and severity (OR 1.03 [0.73, 1.45], p ¼ 0.87; I 2 : 65%). Pooled adjusted OR showed no risk/benefit associated with ACEI/ARB use in terms of mortality (OR 0.83 [0.54, 1.27], p ¼ 0.38; I 2 : 0%). Subgroup analysis showed that the use of ARB was associated with reduced mortality (OR 0.51 [0.29, 0.90], p ¼ 0.02; I 2 : 22%) but not ACEI subgroup (OR 0.68 [0.39, 1.17], p ¼ 0.16; I 2 : 0%). Meta-regression showed that the association between ACEI/ARB use and mortality in patients with COVID-19 do not varies by gender (p ¼ 0.104). GRADE showed a very low certainty of evidence for effect of ACEI/ARB on mortality and severity. The certainty of evidence was very low for both ACEI and ARB subgroups. Conclusion: Administration of a renin angiotensin system (RAS) inhibitor, was not associated with increased mortality or severity of COVID-19 in patients with hypertension. Specifically, ARB and not ACEI use, was associated with lower mortality.

OBJECTIVE: To investigate the association between chronic obstructive pulmonary disease (COPD) and smoking with outcome in patients with COVID-19.METHODS: A systematic literature search was performed using PubMed, EuropePMC, SCOPUS and the Cochrane Central Database. A composite of poor outcome, mortality, severe COVID-19, the need for treatment in an intensive care unit (ICU) and disease progression were the outcomes of interest.RESULTS: Data on 4603 patients were pooled from 21 studies. COPD was associated with an increased risk for composite poor outcome (OR 5.01, 95%CI 3.06–8.22; P < 0.001; I2 0%), mortality (OR 4.36, 95%CI 1.45–13.10; P = 0.009; I2 0%), severe COVID-19 (OR 4.62, 95%CI 2.49–8.56; P < 0.001; I2 0%), ICU care (OR 8.33, 95%CI 1.27–54.56; P = 0.03; I2 0%), and disease progression (OR 8.42, 95%CI 1.60–44.27; P = 0.01; I2 0%). Smoking was found to increase the risk of composite poor outcome (OR 1.52, 95%CI 1.16–2.00; P = 0.005; I2 12%), and subgroup analysis showed that smoking was significant for increased risk of severe COVID-19 (OR 1.65, 95%CI 1.17–2.34; P = 0.004; I2 11%). Current smokers were at higher risk of composite poor outcomes (OR 1.58, 95%CI 1.10–2.27; P = 0.01; I2 0%) than former/non-smokers.CONCLUSION: Our systematic review and meta-analysis revealed that COPD and smoking were associated with poor outcomes in patients with COVID-19.

Objective: The aim of the study was to evaluate the association between chronic kidney disease (CKD) and new onset renal replacement therapy (RRT) with the outcome of Coronavirus Disease 2019 (COVID-19) in patients. Methodology: A systematic literature search from several databases was performed on studies that assessed CKD, use of RRT, and the outcome of COVID-19. The composite of poor outcome consisted of mortality, severe COVID-19, acute respiratory distress syndrome (ARDS), need for intensive care, and use of mechanical ventilator. Results: Nineteen studies with a total of 7216 patients were included. CKD was associated with increased composite poor outcome (RR 2.63 [1.33, 5.17], P = .03; I2 = 51%, P = .01) and its subgroup, consisting of mortality (RR 3.47 [1.36, 8.86], P = .009; I2 = 14%, P = .32) and severe COVID-19 (RR 2.89 [0.98, 8.46], P = .05; I2 = 57%, P = .04). RRT was associated with increased composite poor outcome (RR 18.04 [4.44, 73.25], P < .001; I2 = 87%, P < .001), including mortality (RR 26.02 [5.01, 135.13], P < .001; I2 = 60%, P = .06), severe COVID-19 (RR 12.95 [1.93, 86.82], P = .008; I2 = 81%, P < .001), intensive care (IC) (RR 14.22 [1.76, 114.62], P < .01; I2 = 0%, P < .98), and use of mechanical ventilator (RR 34.39 [4.63, 255.51], P < .0005). Conclusion: CKD and new-onset RRT were associated with poor outcome in patients with COVID-19.