Inpatient omission of ACEi and ARBs is associated with morbidity and mortality in COVID-19

Autor: Christopher Oddy, Polly Keeling, Dhanuja Senn, Neesha Soni, Hannah Morrison, Ruwani Mawella, Thomas Samuel, John Dixon, Jonathan Allington, James McCaul
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Angiotensin-Converting Enzyme Inhibitors
L/min
litres per minute
inpatient
Cohort Studies
ARBs
angiotensin receptor blockers
Medicine
Pharmacology (medical)
Aged
80 and over
biology
Confounding
Middle Aged
Early warning score
ICU
intensive care unit
C-Reactive Protein
ACEi
angiotensin converting enzyme inhibitors
CRP
C-reactive protein
Female
mg/L
milligrams per litre
medicine.drug
Cohort study
severe acute respiratory syndrome coronavirus 2
Adult
medicine.medical_specialty
NEWS-2
national early warning score 2
AKI
acute kidney injury
Article
Angiotensin Receptor Antagonists
Internal medicine
Humans
cardiovascular diseases
Medical prescription
Aged
Retrospective Studies
Pharmacology
Inpatients
business.industry
SARS-CoV-2
COVID-19
Retrospective cohort study
Angiotensin-converting enzyme
Discontinuation
angiotensin receptor blockers
CI
confidence interval
OR
odds ratio
angiotensin converting enzyme inhibitors
ACE inhibitor
biology.protein
Morbidity
business
Zdroj: Clinical Therapeutics
ISSN: 1879-114X
0149-2918
Popis: PURPOSE: Due to the affinity of severe acute respiratory syndrome coronavirus 2 for the human angiotensin-converting enzyme 2 (ACE2) receptor, use of ACE inhibitors and angiotensin receptor blockers (ARBs) has been a major concern for clinicians during the 2020 pandemic. Meta-analyses have affirmed that these agents do not worsen clinical outcomes in patients with severe acute respiratory syndrome coronavirus 2 infection. To date, only a limited number of studies have directly evaluated the safety of inpatient prescription of ACE inhibitors/ARBs during acute coronavirus disease 2019 (COVID-19) illness. METHODS: A retrospective cohort analysis was conducted to investigate the impact of inpatient provision of ACE inhibitors/ARBs on morbidity and mortality in patients admitted to the hospital with COVID-19. Relationships were explored by using linear and logistic regression. FINDINGS: A total of 612 adult patients met the inclusion criteria, of whom 151 (24.7%) patients were established on ACE inhibitors/ARBs. Despite correction for known confounders, discontinuation of ACE inhibitors/ARBs was highly predictive of worsened outcomes in COVID-19. The proportion of doses omitted in the hospital was significantly associated with increased mortality (OR, 9.59; 95% CI, 2.55-36.09; P < 0.001), maximum National Early Warning Score 2 (OR, 1.66; 95% CI, 1.27-2.17; P < 0.001), maximum oxygen requirements (OR, 3.00; 95% CI, 1.83-4.91; P < 0.001), and maximum C-reactive protein concentration (OR, 1.83; 95% CI, 1.06-3.17; P = 0.030). IMPLICATIONS: Our data show a strong association between missed ACE inhibitor/ARB doses with increased morbidity and mortality. The available evidence supports continuation of currently accepted practice surrounding ACE inhibitor/ARB therapy in acute illness, which is to limit drug omission to established acute contraindications, to actively monitor such decisions, and to restart therapy as soon as it is safe to do so. (Clin Ther. 2021;43:XXX-XXX) © 2021 Elsevier HS Journals, Inc.
Databáze: OpenAIRE
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