Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome
Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome
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DOI：
10.1093/infdis/jiaa447
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发表时间：
2020-10-15
影响因子：
6.4
通讯作者：
Duong, Tim Q.
中科院分区：
文献类型：
--
作者：
Lam, Katherine W.;Chow, Kenneth W.;Duong, Tim Q.
背景本研究调查了614例实验室确诊的高血压COVID-19患者住院期间继续和停用血管紧张素转换酶抑制剂（ACEi）或血管紧张素II受体阻滞剂（ARB）的情况。分析人口统计学、合并症、生命体征、实验室数据和ACEi/ARB使用情况。为了解释混杂因素，患者根据在索引住院期间是否发生低血压和急性肾损伤（阿基）进行亚分层。非ACEi/ARB组和ACEi/ARB组的死亡率（22% vs 17%，P > 0.05）和重症监护室（ICU）入院率（26% vs 12%，P > 0.05）无显著差异。然而，在医院继续使用ACEi/ARB的患者的ICU入院率明显较低（12% vs 26%; P = .001;比值比[OR] = 0.347; 95%置信区间[CI]，.187-.643）和死亡率（6% vs 28%; P = 0.001; OR = 0.215; 95% CI，0.101 - 0.455）。在考虑到低血压或AKI的发生后，死亡率的比值比仍然显著降低。这些结果表明，高血压COVID-19患者持续使用ACEi/ARB可获得更好的临床结局。
Background. This study investigated continued and discontinued use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) during hospitalization of 614 hypertensive laboratory-confirmed COVID-19 patients.Methods. Demographics, comorbidities, vital signs, laboratory data, and ACEi/ARB usage were analyzed. To account for confounders, patients were substratified by whether they developed hypotension and acute kidney injury (AKI) during the index hospitalization.Results. Mortality (22% vs 17%, P > .05) and intensive care unit (ICU) admission (26% vs 12%, P > .05) rates were not significantly different between non-ACEi/ARB and ACEi/ARB groups. However, patients who continued ACEi/ARBs in the hospital had a markedly lower ICU admission rate (12% vs 26%; P = .001; odds ratio [OR] = 0.347; 95% confidence interval [CI], .187-.643) and mortality rate (6% vs 28%; P = .001; OR = 0.215; 95% CI, .101-.455) compared to patients who discontinued ACEi/ARB. The odds ratio for mortality remained significantly lower after accounting for development of hypotension or AKI.Conclusions. These findings suggest that continued ACEi/ARB use in hypertensive COVID-19 patients yields better clinical outcomes.