Meta-analysis of the association between angiotensin pathway inhibitors and COVID-19 severity and mortality.
Meta-analysis of the association between angiotensin pathway inhibitors and COVID-19 severity and mortality.
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DOI：
10.1186/s13643-021-01802-6
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发表时间：
2021-09-07
影响因子：
3.7
通讯作者：
Golledge J
中科院分区：
文献类型：
--
作者：
Fernando ME;Drovandi A;Golledge J
相互矛盾的发现以及对未发表和撤回数据的分析导致了血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂对COVID-19感染者的安全性的争议。本荟萃分析研究了血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）处方与COVID-19预后的关系。我们进行了系统搜索，以找到已发表的报告COVID-19结果与ACEI或ARB处方相关的研究。两位作者（MF和AD）独立筛选和提取数据，并使用标准化工具评估研究质量和关联强度。meta分析的终点是基于标准化标准的严重或危重疾病结局和死亡率。26项研究包括8389名服用ACEI或ARB的患者和20989名未服用这些药物的患者。研究的质量参差不齐，相关性的总体强度较差，混杂偏倚的风险较高。服用ACEI或ARB的患者存在更大的危险因素。荟萃分析发现ACEI或ARB处方与严重或危重疾病结局之间存在关联（风险比，RR, 1.23, 95%可信区间，CI, 1.06 ~ 1.42, p = 0.006, I2 = 88%），但在敏感性分析中这种关联丢失。ACEI或ARB处方与死亡率无相关性（RR 1.18, 95% CI 0.92 ~ 1.50, p = 0.19, I2 = 82%）。这项荟萃分析表明，在已发表的被诊断为COVID-19的患者队列中，服用ACEI或ARB的患者更常见的是严重或危重疾病结果，但不是死亡率。这一发现很可能是由于这些患者的危险因素更普遍，而不是由于暴露于血管紧张素途径抑制剂。在线版本包含补充材料，可在10.1186/s13643-021-01802-6获得。
Conflicting findings and the analysis of unpublished and retracted data have led to controversy on the safety of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in people with COVID-19 infection. This meta-analysis examined the association of prescription of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) with the outcome from COVID-19. A systematic search was conducted to find published studies that reported the outcome of COVID-19 in relation to prescription of ACEI or ARB. Two authors (MF and AD) independently screened and extracted data and assessed study quality and strength of association using standardised tools. The endpoints for the meta-analyses were severe or critical disease outcome and mortality based on standardised criteria. Twenty-six studies including 8389 people prescribed ACEI or ARB and 20,989 people not prescribed these medications were included. The quality of studies varied, and the overall strength of association was poor with a high risk of confounding bias. Patients prescribed ACEI or ARB had a greater prevalence of risk factors. Meta-analysis found an association between prescription of ACEI or ARB with severe or critical disease outcome (risk ratio, RR, 1.23, 95% confidence interval, CI, 1.06 to 1.42, p = 0.006, I2 = 88%) but this association was lost in sensitivity analyses. There was no association between ACEI or ARB prescription and mortality (RR 1.18, 95% CI 0.92 to 1.50, p = 0.19, I2 = 82%). This meta-analysis suggests that people prescribed ACEI or ARB more commonly had severe or critical disease outcome, but not mortality, in published cohorts of patients diagnosed with COVID-19. This finding is most likely due to a greater prevalence of risk factors in these patients rather than due to exposure to angiotensin pathway inhibitors. The online version contains supplementary material available at 10.1186/s13643-021-01802-6.
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DOI：
10.1164/rccm.202002-0445oc
发表时间：
2020-06-01
影响因子：
24.7
作者：
Feng, Yun;Ling, Yun;Qu, Jieming
通讯作者：
Qu, Jieming
影响因子：
11.8
作者：
Gnavi, Roberto;Demaria, Moreno;Costa, Giuseppe
通讯作者：
Costa, Giuseppe
影响因子：
4.9
作者：
Bavishi C;Whelton PK;Mancia G;Corrao G;Messerli FH
通讯作者：
Messerli FH
影响因子：
2
作者：
Kulinskaya, Elena;Morgenthaler, Stephan;Staudte, Robert G.
通讯作者：
Staudte, Robert G.
影响因子：
3.4
作者：
Chu C;Zeng S;Hasan AA;Hocher CF;Krämer BK;Hocher B
通讯作者：
Hocher B