Comparative analysis between the use of renin–angiotensin system antagonists and clinical outcomes of hospitalized patients with COVID-19 respiratory infection

Río, Jorge Martínez-del; Piqueras‐Flores, Jesús; Sierra, Patricia; Negreira-Caamaño, Martín; Águila-Gordo, Daniel; Mateo-Gómez, Cristina; Salas-Bravo, Daniel; Rodríguez-Martínez, Marta

doi:10.1016/j.medcle.2020.07.013

Cited by 10 publications

(10 citation statements)

References 27 publications

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“…The grade of GF was not associated with a greater risk of infection by SARS-CoV-2 or to a greater mortality in contrast to what has been described in hospital studies such as that by the COVID-19@Spain Study Group [ 24 ]. Neither were chronic treatments with ACE or ARB-II [ 52 ] or acute treatments with corticoids [ 53 ] related to mortality, although this subgroup of patients was very small. In this sense, of note is the importance of the information provided by studies of prognostic factors of morbidity and mortality by COVID-19, by populational and community bases, in contrast to studies in the hospital setting [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People

Agoües

Gallego

Resa

et al. 2021

IJERPH

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Background: SARS-CoV-2 has caused a high mortality in institutionalised individuals. There are very few studies on the involvement and the real impact of COVID-19 in nursing homes. This study analysed factors related to morbidity and mortality of COVID-19 in institutionalised elderly people. Methods: This cohort study included 842 individuals from 12 nursing homes in Sant Cugat del Vallès (Spain) from 15 March to 15 May 2020. We evaluated individual factors (demographic, dependence, clinical, and therapeutic) and those related to the nursing homes (size and staff) associated with infection and mortality by SARS-CoV-2. Infection was diagnosed by molecular biology test. Results: Of the 842 residents included in the analysis, 784 underwent a Polymerase Chain Reaction (PCR) test; 74.2% were women, the mean age was 87.1 years, and 11.1% died. The PCR test was positive in 44%. A total of 33.4% of the residents presented symptoms compatible with COVID-19 and of these, 80.9% were PCR-positive for SARS-CoV-2. Infection by SARS-CoV-2 among residents was associated with the rate of staff infected in the homes. Mortality by SARS-CoV-2 was related to male sex and a greater grade of dependence measured with the Barthel index. Conclusions: SARS-Cov-2 infection in institutionalised people is associated with the infection rate in nursing home workers and mortality by SARS-Cov-2 with sex and greater dependency according to the Barthel index. Adequate management of nursing home staff and special attention to measures of infection control, especially of individuals with greater dependence, are keys for successful management of future pandemic situations.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People

Agoües

Gallego

Resa

et al. 2021

IJERPH

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“…Among the 56 individual studies (two of which combined an individual study and a meta-analysis [25,26]), 12 included both in-and outpatients and 44 included only inpatients. Among the 44 inpatients studies, 30 assessed the effect of chronic use and 12 the effect of in-hospital use, 3 of which assessed both chronic and in-hospital use [27][28][29]. Timing of exposure measurement was uncertain in five of 44.…”

Section: R Esultsmentioning

confidence: 99%

Chronic use of renin‐angiotensin‐aldosterone system blockers and mortality in COVID‐19: A multicenter prospective cohort and literature review

Gault¹,

Esposito-Farèse²,

Revest³

et al. 2021

Fundamemntal Clinical Pharma

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Aims:The role of renin-angiotensin-aldosterone system (RAAS) blockers on the course of coronavirus disease 2019 (COVID-19) is debated. We assessed the association between chronic use of RAAS blockers and mortality among inpatients with COVID-19 and explored reasons for discrepancies in the literature. Methods and results:We included adult hypertensive patients from a prospective nationwide cohort of 3512 inpatients with COVID-19 up to June 30, 2020. Cox proportional hazard models with various adjustment or propensity weighting methods were used to estimate the hazard ratios (HR) of 30-day mortality for chronic users versus non-users of RAAS blockers. We analyzed data of 1160 hypertensive patients: 719 (62%) were male and 777 (67%) were older than 65 years. The main comorbidities were diabetes (n = 416, 36%), chronic cardiac disease (n = 401, 35%), and obesity (n = 340, 29%); 705 (61%) received oxygen therapy. We recorded 135 (11.6%) deaths within 30 days of diagnosis. We found no association between chronic use of RAAS blockers and mortality (unadjusted HR = 1.13, 95% CI [0.8-1.6]; propensity inverse probability treatment weighted HR = 1.09 [0.86-1.39]; propensity standardized mortality ratio weighted HR = 1.08 [0.79-1.47]). Our comprehensive review of previous studies highlighted that significant associations were mostly found in unrestricted populations with inappropriate adjustment, or with biased in-hospital exposure measurement. Conclusion:Our results do not support previous concerns regarding these drugs, nor a potential protective effect as reported in previous poorly designed studies and meta-analyses. RAAS blockers should not be discontinued during the pandemic, while in-hospital management of these drugs will be clarified by randomized trials. NCT04262921.

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“…Thirty studies 7,19,24,25,27,[29][30][31][32][33]35,37,41,43,45,[48][49][50][51]53,59,60,62,63,[65][66][67][68][69]71,72 (58%) reported data on PaO2/FiO2. The median PaO2/FiO2 at admission ranged from 60 mmHg 44 to 442 mmHg 32 .…”

Section: Gas Exchange At Admissionmentioning

confidence: 99%

Characteristics, outcomes and global trends of respiratory support in patients hospitalized with COVID-19 pneumonia: a scoping review

Radovanovic¹,

Santus²,

Coppola³

et al. 2021

Minerva Anestesiol

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Comparative analysis between the use of renin–angiotensin system antagonists and clinical outcomes of hospitalized patients with COVID-19 respiratory infection

Cited by 10 publications

References 27 publications

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People

Chronic use of renin‐angiotensin‐aldosterone system blockers and mortality in COVID‐19: A multicenter prospective cohort and literature review

Characteristics, outcomes and global trends of respiratory support in patients hospitalized with COVID-19 pneumonia: a scoping review

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