Renin–angiotensin system inhibitors and the severity of coronavirus disease 2019 in Kanagawa, Japan: a retrospective cohort study

Autor: Keisuke Iwabuchi, Kenichiro Saka, Masaaki Konishi, Kengo Tsukahara, Hisao Ogawa, Toshio Hirano, Yu Yamada, Jin Kirigaya, Kazuo Kimura, Kouichi Tamura, Ichiro Takeuchi, Hiroyuki Shimizu, Yasushi Matsuzawa, Kazuki Fukui
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
Physiology
Pneumonia
Viral
Angiotensin-Converting Enzyme Inhibitors
030204 cardiovascular system & hematology
Severity of Illness Index
law.invention
03 medical and health sciences
Betacoronavirus
0302 clinical medicine
law
Diabetes mellitus
Internal medicine
Severity of illness
Internal Medicine
Medicine
Humans
030212 general & internal medicine
Confusion
Pandemics
Aged
Retrospective Studies
Aged
80 and over
biology
business.industry
SARS-CoV-2
Age Factors
COVID-19
Retrospective cohort study
Angiotensin-converting enzyme
Odds ratio
Middle Aged
medicine.disease
Angiotensin II
Intensive care unit
Angiotensin-converting enzyme 2
Hypertension
biology.protein
Female
business
Coronavirus Infections
Cardiology and Cardiovascular Medicine
Angiotensin II Type 1 Receptor Blockers
Zdroj: Hypertension Research
ISSN: 1348-4214
0916-9636
DOI: 10.1038/s41440-020-00535-8
Popis: Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak initiated on the Diamond Princess Cruise Ship at Yokohama harbor in February 2020, we have been doing our best to treat COVID-19 patients. In animal experiments, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II type-1 receptor blockers (ARBs) are reported to suppress the downregulation of angiotensin converting enzyme 2 (ACE2), and they may inhibit the worsening of pathological conditions. We aimed to examine whether preceding use of ACEIs and ARBs affected the clinical manifestations and prognosis of COVID-19 patients. One hundred fifty-one consecutive patients (mean age 60 ± 19 years) with polymerase-chain-reaction proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to six hospitals in Kanagawa Prefecture, Japan, were analyzed in this multicenter retrospective observational study. Among all COVID-19 patients, in the multiple regression analysis, older age (age ≥ 65 years) was significantly associated with the primary composite outcome (odds ratio (OR) 6.63, 95% confidence interval (CI) 2.28-22.78, P < 0.001), which consisted of (i) in-hospital death, (ii) extracorporeal membrane oxygenation, (iii) mechanical ventilation, including invasive and noninvasive methods, and (iv) admission to the intensive care unit. In COVID-19 patients with hypertension, preceding ACEI/ARB use was significantly associated with a lower occurrence of new-onset or worsening mental confusion (OR 0.06, 95% CI 0.002-0.69, P = 0.02), which was defined by the confusion criterion, which included mild disorientation or hallucination with an estimation of medical history of mental status, after adjustment for age, sex, and diabetes. In conclusion, older age was a significant contributor to a worse prognosis in COVID-19 patients, and ACEIs/ARBs could be beneficial for the prevention of confusion in COVID-19 patients with hypertension.
Databáze: OpenAIRE
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