Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome

Lam, Katherine W; Chow, Kenneth W.; Vo, Jonathan; Hou, Wei; Li, Haifang; Richman, Paul; Mallipattu, Sandeep K.; Skopicki, Hal A.; Singer, Adam J.; Duong, Timothy Q.

doi:10.1093/infdis/jiaa447

Cited by 107 publications

(116 citation statements)

References 32 publications

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“…[56][57][58][59][60] Some recent studies support this view, and populationbased reports revealed that the use of ACEI and ARB inhibitors in patients with COVID-19 does not aggravate the severity of the disease, increase the risk of infection, improve prognosis, or reduce mortality. [61][62][63][64][65][66] In addition, a systematic review and meta-analysis of related research has reconfirmed this thesis. [67][68][69][70][71] Given that hypertension and CVD can increase the severity of the disease, dividing patients without hypertensive and CVD into a non-ACEI/ARB group may underestimate the favorable effects of ACEI/ARB drugs on affected patients.…”

Section: Sars-cov-2mentioning

confidence: 61%

<p>Role of Renin-Angiotensin System in Acute Lung Injury Caused by Viral Infection</p>

Gao¹,

Du²,

Zhang³

et al. 2020

IDR

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The renin-angiotensin system (RAS) is the most important regulatory system of electrolyte homeostasis and blood pressure and acts through angiotensin-converting enzyme (ACE)/angiotensin II (Ang II)/Ang II type 1 (AT1) receptor axis and angiotensin-converting enzyme 2 (ACE2)/angiotensin (1-7)/MAS receptor axis. RAS dysfunction is related to the occurrence and development of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) and causes a serious prognosis and even death. ALI/ARDS can be induced by various ways, one of which is viral infections, such as SARS-CoV, SARS-CoV-2, H5N1, H7N9, and EV71. This article reviews the specific mechanism on how RAS dysfunction affects ALI/ARDs caused by viral infections. SARS-CoV and SARS-CoV-2 enter the host cells by binding with ACE2. H5N1 and H7N9 avian influenza viruses reduce the ACE2 level in the body, and EV71 increases Ang II concentration. Treatment with angiotensin-converting enzyme inhibitor and angiotensin AT1 receptor blocker can alleviate ALI/ARDS symptoms. This review provides suggestions for the treatment of lung injury caused by viral infections.

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Section: Sars-cov-2mentioning

confidence: 61%

<p>Role of Renin-Angiotensin System in Acute Lung Injury Caused by Viral Infection</p>

Gao¹,

Du²,

Zhang³

et al. 2020

IDR

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show abstract

“…The spatiotemporal characteristics on pCXR of COVID-19 infection and its relation to clinical outcomes are unknown. Future endeavors could include developing AI algorithms to stage severity, and predict progression, treatment response, recurrence, and survival, to inform and advise risk management and resource allocation associated with the COVID-19 pandemic, with inclusion of clinical variables in predictive models (Lam et al, 2020;Zhao et al, 2020;Zhu et al, 2020b).…”

Section: Discussionmentioning

confidence: 99%

Deep-learning convolutional neural networks with transfer learning accurately classify COVID-19 lung infection on portable chest radiographs

Kikkisetti

Zhu

Shen

et al. 2020

PeerJ

Self Cite

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Portable chest X-ray (pCXR) has become an indispensable tool in the management of Coronavirus Disease 2019 (COVID-19) lung infection. This study employed deep-learning convolutional neural networks to classify COVID-19 lung infections on pCXR from normal and related lung infections to potentially enable more timely and accurate diagnosis. This retrospect study employed deep-learning convolutional neural network (CNN) with transfer learning to classify based on pCXRs COVID-19 pneumonia (N = 455) on pCXR from normal (N = 532), bacterial pneumonia (N = 492), and non-COVID viral pneumonia (N = 552). The data was randomly split into 75% training and 25% testing, randomly. A five-fold cross-validation was used for the testing set separately. Performance was evaluated using receiver-operating curve analysis. Comparison was made with CNN operated on the whole pCXR and segmented lungs. CNN accurately classified COVID-19 pCXR from those of normal, bacterial pneumonia, and non-COVID-19 viral pneumonia patients in a multiclass model. The overall sensitivity, specificity, accuracy, and AUC were 0.79, 0.93, and 0.79, 0.85 respectively (whole pCXR), and were 0.91, 0.93, 0.88, and 0.89 (CXR of segmented lung). The performance was generally better using segmented lungs. Heatmaps showed that CNN accurately localized areas of hazy appearance, ground glass opacity and/or consolidation on the pCXR. Deep-learning convolutional neural network with transfer learning accurately classifies COVID-19 on portable chest X-ray against normal, bacterial pneumonia or non-COVID viral pneumonia. This approach has the potential to help radiologists and frontline physicians by providing more timely and accurate diagnosis.

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“…Richardson et al showed an increasing trend in mortality in ACE-I and ARB users compared with nonusers, with approximately 50% of the patients discontinuing the drug in the course of hospitalization 22 . Lam et al compared COVID-19 patients who continued and discontinued ACE-I or ARB after excluding cases of hypotension and AKI 35 . Patients who could continue ACE-I or ARB demonstrated lower mortality and intensive care unit admission rates.…”

Section: Discussionmentioning

confidence: 99%

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

Lim

Cho

Jeon

et al. 2020

Preprint

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We investigated the association between angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) and the risk of mortality in hospitalized severe COVID-19 patients. A retrospective cohort study was performed on all hospitalized COVID-19 patients in tertiary hospitals in Daegu, Korea. Patients were classified based on whether they received ACE-I or ARB before COVID-19 diagnosis. The Cox proportional hazards regression model was used for the analysis of survival. Of 130 COVID-19 patients, 30 (23.1%) who received ACE-I or ARB showed an increased the risk of in-hospital mortality (adjusted HR, 2.15; 95% CI, 1.04 to 4.44; P = 0.038). ACE-I or ARB were also associated with acute respiratory distress syndrome or mechanical ventilation (adjusted OR, 3.38; 95% CI, 1.18 to 9.69; P = 0.024), and acute kidney injury or shock (adjusted OR, 2.81; 95% CI, 1.04 to 7.56; P = 0.042). Among the patients with ACE-I or ARB, 14 (46.7%) discontinued the therapy and the cessation was associated with a higher mortality rate. ACE-I or ARB therapy in severe COVID-19 patients was associated with occurrence of severe complications and increased in-hospital mortality. Discontinuation of ACE-I or ARB in patients with more severe COVID-19 was not associated with improvement of mortality.

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Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome

Cited by 107 publications

References 32 publications

<p>Role of Renin-Angiotensin System in Acute Lung Injury Caused by Viral Infection</p>

<p>Role of Renin-Angiotensin System in Acute Lung Injury Caused by Viral Infection</p>

Deep-learning convolutional neural networks with transfer learning accurately classify COVID-19 lung infection on portable chest radiographs

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

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