Inhibitors of the renin–angiotensin system: The potential role in the pathogenesis of COVID-19

Huang, Ziyin; Jiang, Yufeng; Chen, Jingjing; Zhou, Yafeng

doi:10.5603/cj.a2020.0056

Cited by 13 publications

(11 citation statements)

References 22 publications

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“…Our results support the administration of anticoagulant drugs at proper doses in all COVID-19 patients, as also suggested by some guidelines (37)(38). The possible beneficial, harmful or neutral role of ACEI or ARB remains a matter of debate, and larger studies are probably needed (39,40).…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study

et al. 2020

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The aim of the study was to assess simultaneously several potential predictors of outcome (co-morbidity, previous and in-hospital treatment, radiologic Brixia score) in patients with COVID-19. This retrospective cohort study included 258 consecutive patients with confirmed COVID-19 admitted to a medical ward at the Montichiari Hospital, Brescia, Italy from February 28th to April 30th, 2020. Patients had COVID-19 related pneumonia with respiratory failure, and were treated with hydroxychloroquine, lopinavir plus ritonavir. In some patients additional treatment with tocilizumab, dexamethasone and enoxaparin was adopted. Outcomes (death or recovery) were assessed at the end of the discharge period or at the end the follow-up (August 2020). During hospitalization, 59 patients died, while 6 died after discharge. The following variables were demonstrated to be associated with a worse prognosis: Radiologic Brixia score higher than 8, presence at baseline of hypertension, diabetes, chronic obstructive pulmonary disease, heart disease, cancer, previous treatment with ACE-inhibitors or anti-platelet drugs. Anticoagulant treatment during hospital admission with enoxaparin at a dose higher than 4000 U per was associated to a better prognosis. In conclusion, our study demonstrates that some co-morbidities and cardiovascular risk factors may affect prognosis. The radiologic Brixia score may be a useful tool for stratifying the risk of death at baseline. Anticoagulant treatment with enoxaparin might be associated to a clinical benefit in terms of survival in patients with COVID-19.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study

et al. 2020

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“…Cardiovascular morbidity has also been associated with both worse outcomes in COVID-19. Whether the excess of mortality in patients with myocardial injury can be explained by the higher prevalence of comorbidities in this population is still a subject of discussion [4,[9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients

et al. 2020

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Background: Despite being associated with worse prognosis in patients with COVID-19, systematic determination of myocardial injury is not recommended. The aim of the study was to study the effect of myocardial injury assessment on risk stratification of COVID-19 patients. Methods: Seven hundred seven consecutive adult patients admitted to a large tertiary hospital with confirmed COVID-19 were included. Demographic data, comorbidities, laboratory results and clinical outcomes were recorded. Charlson comorbidity index (CCI) was calculated in order to quantify the degree of comorbidities. Independent association of cardiac troponin I (cTnI) increase with outcomes was evaluated by multivariate regression analyses and area under curve. In addition, propensity-score matching was performed to assemble a cohort of patients with similar baseline characteristics.Results: In the matched cohort (mean age 66.76 ± 15.7 years, 37.3% females), cTnI increase above the upper limit was present in 20.9% of the population and was associated with worse clinical outcomes, including all-cause mortality within 30 days (45.1% vs. 23.2%; p = 0.005). The addition of cTnI to a multivariate prediction model showed a significant improvement in the area under the time-dependent receiver operating characteristic curve (0.775 vs. 0.756, DC-statistic = 0.019; 95% confidence interval 0.001-0.037). Use of renin-angiotensin-aldosterone system inhibitors was not associated with mortality after adjusting by baseline risk factors. Conclusions: Myocardial injury is independently associated with adverse outcomes irrespective of baseline comorbidities and its addition to multivariate regression models significantly improves their performance in predicting mortality. The determination of myocardial injury biomarkers on hospital admission and its combination with CCI can classify patients in three risk groups (high, intermediate and low) with a clearly distinct 30-day mortality.

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“…ACE2 is mainly present in the lungs and small intestines and it converts Ag II to Ag (1 -7), which binds to Mas receptor producing anti-inflammatory and anti-fibrinolytic activities. On the other hand, activation of Ag II receptors by Ag II results in proinflammatory and pro-fibrinolytic activities [14]. As discussed earlier, ACE2 is the main host receptor responsible for the internalization of SARS-CoV-2 through interaction with the S protein on the viral cell surface [4].…”

Section: Impact Of Covid-19 On Renin Angiotensin (Ag) Aldosterone System (Raas)mentioning

confidence: 98%

“…The RAAS starts with renin cleaving angiotensinogen to Ag 1 which is further cleaved by ACE to Ag 2. Ag II binds to Ag II receptors 1 and 2 [14].…”

Section: Impact Of Covid-19 On Renin Angiotensin (Ag) Aldosterone System (Raas)mentioning

confidence: 99%

Coronavirus Disease 2019: An Overview of the Complications and Management

Shao

Ghaly

Varamini

2021

INNOSC Theranostics and Pharmacological Sciences

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The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). Since the first report of COVID-19 emerging in Wuhan, China, authorities in 216 countries and territories have reported about 47.3 million COVID-19 cases and 1.2 million deaths. The WHO guidelines for the management of COVID-19 are very limited to recommendations for managing symptoms and advice on careful management of pediatric patients, pregnant women, and patients with underlying comorbidities. There is no approved treatment for COVID-19 and guidelines vary between countries. In this review, first, a brief overview is provided on the basic knowledge about the virus, clinical features of the disease, and different diagnostic methods. Then, the relationship between COVID-19, various body systems, and other complications is discussed. Finallly, different management strategies are discussed, including those drawn on computational chemistry analyses, pre-clinical investigations, and clinical trials which involve pharmacological and non-pharmacological interventions. In conclusion, despite the recent approval of different vaccine candidates, more virological characteristics of SARS-CoV-2 are required to be explored, which may result in the discovery of more potential therapeutic targets leading to safer and more effective treatment to COVID-19.

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Inhibitors of the renin–angiotensin system: The potential role in the pathogenesis of COVID-19

Cited by 13 publications

References 22 publications

Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study

Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study

Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients

Coronavirus Disease 2019: An Overview of the Complications and Management

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