Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19,Critical Care Medicine

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Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19
Critical Care Medicine ( IF 7.7 ) Pub Date : 2022-10-01 , DOI: 10.1097/ccm.0000000000005627
Neha Gupta ₁ , Lisa Settle ₂ , Brent R Brown ₃ , Donna L Armaignac ₄ , Michael Baram ₅ , Nicholas E Perkins ₆ , Margit Kaufman ₇ , Roman R Melamed ₈ , Amy B Christie ₉ , Valerie C Danesh ₁₀ , Joshua L Denson ₁₁ , Sreekanth R Cheruku ₁₂ , Karen Boman ₁₃ , Vikas Bansal ₁₄ , Vishakha K Kumar ₁₃ , Allan J Walkey ₁₅ , Juan P Domecq ₁₆ , Rahul Kashyap ₁₄ , Christopher E Aston ₁₇ ,

Affiliation

Department of Pediatrics, Division of Pediatric Critical Care, University of Oklahoma College of Medicine, Oklahoma City, OK.
Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK.
Department of Medicine, Division of Pulmonary Critical Care, University of Oklahoma College of Medicine, Oklahoma City, OK.
Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL.
Department of Medicine, Thomas Jefferson University, Philadelphia, PA.
Department of Medicine, Division of Hospital Medicine, Prisma Health, Greenville, SC.
Departments of Anesthesiology and Critical Care Medicine, Englewood Health, Englewood, NJ.
Department of Critical Care, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN.
Department of Critical Care, Atrium Health Navicent, Macon, GA.
Center for Applied Health Research, Baylor Scott & White Health, Dallas, TX.
Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA.
Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX.
Society of Critical Care Medicine, Mount Prospect, IL.
Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN.
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, and Evans Center of Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, MA.
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Biomedical and Behavioral Methodology Core, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK.

OBJECTIVES:

To determine the association of prior use of renin-angiotensin-aldosterone system inhibitors (RAASIs) with mortality and outcomes in hospitalized patients with COVID-19.

DESIGN:

Retrospective observational study.

SETTING:

Multicenter, international COVID-19 registry.

Subjects:

Adult hospitalized COVID-19 patients on antihypertensive agents (AHAs) prior to admission, admitted from March 31, 2020, to March 10, 2021.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Data were compared between three groups: patients on RAASIs only, other AHAs only, and those on both medications. Multivariable logistic and linear regressions were performed after controlling for prehospitalization characteristics to estimate the effect of RAASIs on mortality and other outcomes during hospitalization. Of 26,652 patients, 7,975 patients were on AHAs prior to hospitalization. Of these, 1,542 patients (19.3%) were on RAASIs only, 3,765 patients (47.2%) were on other AHAs only, and 2,668 (33.5%) patients were on both medications. Compared with those taking other AHAs only, patients on RAASIs only were younger (mean age 63.3 vs 66.9 yr; p < 0.0001), more often male (58.2% vs 52.4%; p = 0.0001) and more often White (55.1% vs 47.2%; p < 0.0001). After adjusting for age, gender, race, location, and comorbidities, patients on combination of RAASIs and other AHAs had higher in-hospital mortality than those on RAASIs only (odds ratio [OR] = 1.28; 95% CI [1.19–1.38]; p < 0.0001) and higher mortality than those on other AHAs only (OR = 1.09; 95% CI [1.03–1.15]; p = 0.0017). Patients on RAASIs only had lower mortality than those on other AHAs only (OR = 0.87; 95% CI [0.81–0.94]; p = 0.0003). Patients on ACEIs only had higher mortality compared with those on ARBs only (OR = 1.37; 95% CI [1.20–1.56]; p < 0.0001).

CONCLUSIONS:

Among patients hospitalized for COVID-19 who were taking AHAs, prior use of a combination of RAASIs and other AHAs was associated with higher in-hospital mortality than the use of RAASIs alone. When compared with ARBs, ACEIs were associated with significantly higher mortality in hospitalized COVID-19 patients.

中文翻译：

肾素血管紧张素醛固酮系统抑制剂与住院 COVID-19 患者结局的关系

目标：

旨在确定既往使用肾素-血管紧张素-醛固酮系统抑制剂(RAASI) 与住院 COVID-19 患者的死亡率和结局之间的关系。

设计：

回顾性观察研究。

环境：

多中心、国际 COVID-19 登记处。

科目：

2020 年 3 月 31 日至 2021 年 3 月 10 日期间入院的入院前服用抗高血压药物 (AHA) 的成人住院 COVID-19 患者。

干预措施：

没有任何。

测量和主要结果：

比较了三组之间的数据：仅服用 RAASI 的患者、仅服用其他 AHA 的患者以及同时服用两种药物的患者。在控制院前特征后进行多变量逻辑回归和线性回归，以估计 RAASI 对住院期间死亡率和其他结果的影响。在 26,652 名患者中，7,975 名患者在住院前服用 AHA。其中，1,542 名患者 (19.3%) 仅服用 RAASI，3,765 名患者 (47.2%) 仅服用其他 AHA，2,668 名患者 (33.5%) 服用两种药物。与仅服用其他 AHA 的患者相比，仅服用 RAASI 的患者更年轻（平均年龄 63.3 岁 vs 66.9 岁； p < 0.0001），男性更常见（58.2% vs 52.4%； p = 0.0001），白人更常见（55.1% vs 47.2） %； p < 0.0001)。调整年龄、性别、种族、地点和合并症后，接受 RAASI 和其他 AHA 联合治疗的患者比仅接受 RAASI 治疗的患者院内死亡率更高（比值比 [OR] = 1.28；95% CI [1.19–1.38] ; p < 0.0001）并且死亡率高于仅使用其他 AHA 的患者（OR = 1.09；95% CI [1.03–1.15]； p = 0.0017）。仅接受 RAASI 治疗的患者死亡率低于仅接受其他 AHA 治疗的患者（OR = 0.87；95% CI [0.81–0.94]； p = 0.0003）。与仅使用 ARB 的患者相比，仅使用 ACEI 的患者死亡率较高（OR = 1.37；95% CI [1.20–1.56]； p < 0.0001）。