Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Use Associated with Reduced Mortality and Other Disease Outcomes in US Veterans with COVID-19.
Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Use Associated with Reduced Mortality and Other Disease Outcomes in US Veterans with COVID-19.
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DOI：
10.1007/s40265-021-01639-2
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发表时间：
2022-01
期刊：
影响因子：
11.5
通讯作者：
Ahluwalia A
中科院分区：
文献类型：
--
作者：
Rizk JG;Wenziger C;Tran D;Hashemi L;Moradi H;Streja E;Ahluwalia A
确定血管紧张素转换酶抑制剂（ACEIs）或血管紧张素II受体阻滞剂（ARB）使用与美国退伍军人2019冠状病毒病（COVID-19）严重程度和结局之间的相关性。我们回顾性检查了2020年3月至11月期间COVID-19检测呈阳性的27，556名成年美国退伍军人。根据COVID-19阳性病例日期前6个月内ACEI和/或ARB处方，使用倾向评分（PS）进行权重、调整和匹配的Logistic回归和考克斯比例风险模型分别检查COVID-19阳性病例日期后60天内事件的几率和至死亡的时间。重叠PS加权logistic回归模型显示，ACEI或ARB处方的重症监护病房（ICU）入院（比值比[OR] 95% CI 0.77，0.61-0.98）和60天内死亡（0.87，0.79-0.97）的比值较低。仅使用ARB处方的退伍军人入住ICU的几率也较低（0.64，0.44-0.92）。重叠PS加权模型同样显示，ACEI或ARB处方（HR [95% CI]：0.87，0.79-0.97）和仅ARB处方（0.78，0.67-0.91）的退伍军人的全因死亡时间风险较低。接受ACEI处方的退伍军人在COVID-19阳性病例日期后60天内发生脓毒症事件的几率更高（1.22，1.02-1.46）。在这项针对美国退伍军人全国队列的研究中，我们发现COVID-19患者使用ACEI/ARB与死亡率增加和其他更糟糕的结果无关。未来的研究应探讨潜在的途径，并进一步证实ACEI处方与脓毒症的关系。在线版本包含补充材料，可通过10.1007/s40265-021-01639-2获得。
To determine the association between angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) use and coronavirus disease 2019 (COVID-19) severity and outcomes in US veterans. We retrospectively examined 27,556 adult US veterans who tested positive for COVID-19 between March to November 2020. Logistic regression and Cox proportional hazards models using propensity score (PS) for weight, adjustment, and matching were used to examine the odds of an event within 60 days following a COVID-19–positive case date and time to death, respectively, according to ACEI and/or ARB prescription within 6 months prior to the COVID-19–positive case date. The overlap PS weighted logistic regression model showed lower odds of an intensive care unit (ICU) admission (odds ratio [OR] 95% CI 0.77, 0.61–0.98) and death within 60 days (0.87, 0.79–0.97) with an ACEI or ARB prescription. Veterans with an ARB-only prescription also had lower odds of an ICU admission (0.64, 0.44–0.92). The overlap PS weighted model similarly showed a lower risk of time to all-cause mortality in veterans with an ACEI or ARB prescription (HR [95% CI]: 0.87, 0.79–0.97) and an ARB only prescription (0.78, 0.67–0.91). Veterans with an ACEI prescription had higher odds of experiencing a septic event within 60 days after the COVID-19–positive case date (1.22, 1.02–1.46). In this study of a national cohort of US veterans, we found that the use of an ACEI/ARB in patients with COVID-19 was not associated with increased mortality and other worse outcomes. Future studies should examine underlying pathways and further confirm the relationship of ACEI prescription with sepsis. The online version contains supplementary material available at 10.1007/s40265-021-01639-2.
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