Renin-angiotensin-system inhibitors and all-cause mortality in patients with COVID-19: a systematic review and meta-analysis of observational studies.
Renin-angiotensin-system inhibitors and all-cause mortality in patients with COVID-19: a systematic review and meta-analysis of observational studies.
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DOI：
10.1097/hjh.0000000000002784
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发表时间：
2021-04-01
影响因子：
4.9
通讯作者：
Messerli FH
中科院分区：
文献类型：
--
作者：
Bavishi C;Whelton PK;Mancia G;Corrao G;Messerli FH
我们试图评估血管紧张素转换酶抑制剂（ACEI）或AT 1阻滞剂（ARB）治疗与2019冠状病毒病（COVID-19）患者临床结局的相关性。检索电子数据库，以确定已发表的研究，这些研究报告了正在服用或未服用ACEI/ARB的COVID-19患者的临床结局。我们研究了全因死亡率和/或严重疾病结局。使用随机效应模型汇总了各个研究的完全调整的效应估计值。总共有34项研究（31项队列研究和3项病例对照研究）符合我们的合格标准。由于队列研究和病例对照研究之间的固有差异，我们没有将这些研究的结果联合收割机，而是使用它们来确定其结果的一致性。31项队列研究提供了87951例COVID-19患者的结局数据，其中22383/83963（26.7%）接受ACEI/ARB治疗。在汇总分析中，我们发现ACEI/ARB的使用与全因死亡率/严重疾病[相对危险度：0.94，95%可信区间（CI）：0.86-1.03，I2 = 57%，P = 0.20]或严重疾病的发生率之间无相关性。（相对危险度：0.93，95%CI：20.74-1.17，I2 = 56%，P = 0.55）。对三项基于人群的病例对照研究的分析表明，ACEI/ARB（合并比值比：1.00，95%CI：0.81-1.23，I2 = 0，P = 0.98）与全因死亡率/严重疾病之间无显著相关性。在31项队列研究中的13项以及3项分别报告ACEI和ARB结局的病例对照研究中，死亡率/严重疾病结局无差异效应。在COVID-19患者中，我们发现ACEI/ARB治疗与死亡率/严重疾病之间没有关联。除非有临床指征，否则不应停用ACEI/ARB。
We sought to evaluate the association of angiotensin-converting-enzyme inhibitors (ACEI) or AT1 blockers (ARB) therapy with clinical outcomes in patients with coronavirus disease 2019 (COVID-19). Electronic databases were searched to identify published studies that reported clinical outcomes in patients with COVID-19 who were or were not taking an ACEI/ARB. We studied all-cause mortality and/or severe disease outcomes. Fully adjusted effect estimates from individual studies were pooled using a random-effects model. In total, 34 (31 cohort-based and three case–control) studies met our eligibility criteria. Due to the inherent differences between cohort and case–control studies, we did not combine results of these studies but used them to identify the consistency of their results. The 31 cohort studies provided outcome data for 87 951 patients with COVID-19, of whom 22 383/83 963 (26.7%) were on ACEI/ARB therapy. In pooled analysis, we found no association between the use of ACEI/ARB and all-cause mortality/severe disease [relative risk: 0.94, 95% confidence interval (CI): 0.86–1.03, I2 = 57%, P = 0.20] or occurrence of severe disease (relative risk: 0.93, 95% CI: 20.74–1.17, I2 = 56%, P = 0.55). Analysis of three population-based case–control studies identified no significant association between ACEI/ARB (pooled odds ratio: 1.00, 95% CI: 0.81–1.23, I2 = 0, P = 0.98) and all-cause mortality/severe disease. In 13 of the 31 cohort studies as well as in three case–control studies that reported outcomes separately for ACEI and ARB, there was no differential effect for mortality/severe disease outcomes. In patients with COVID-19, we found no association between ACEI/ARB treatment and mortality/severe disease. ACEI/ARB should not be discontinued, unless clinically indicated.