Association of renin-angiotensin-aldosterone system inhibitors with mortality and testing positive of COVID-19: Meta-analysis
Association of renin-angiotensin-aldosterone system inhibitors with mortality and testing positive of COVID-19: Meta-analysis
复制标题
DOI：
10.1002/jmv.26588
复制
发表时间：
2020-10-30
影响因子：
12.7
通讯作者：
Kuno, Toshiki
中科院分区：
文献类型：
--
作者：
Yokoyama, Yujiro;Aikawa, Tadao;Kuno, Toshiki
一些人假设使用血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）可能会改变人类对2019冠状病毒病（COVID-19）的易感性。因此，我们进行了两项荟萃分析，以研究ACEI和ARB对死亡率和COVID-19易感性的影响。检索了截至2020年6月的Pubmed和EMBASE，以确定调查接受ACEI和/或ARB治疗的患者以及未接受ACEI或ARB治疗的患者的COVID-19检测阳性率和住院死亡率的临床试验。第一项分析调查了COVID-19的检测阳性率。第二项分析调查了COVID-19患者的住院死亡率。第一次分析确定了3项合格研究，第二次分析确定了14项合格研究。第一项分析表明，ACEI或ARB的使用不影响检测阳性率（比值比[OR] [置信区间[CI]] = 0.96 [0.88-1.04]; p = 0.69，OR [CI] = 0.99 [0.91-1.08]; p = 0.35）。第二项分析显示，ACEI和/或ARB的使用不影响住院死亡率（风险比[RR] 95% [CI]] = 0.88 [0.64-1.20]，p = 0.42）。通过限制性研究对高血压患者进行的亚组分析显示，与不使用ACEI或ARB相比，使用ACEI和/或ARB与住院死亡率显著降低相关（RR [CI] = 0.66 [0.49-0.89]，p = 0.004）。我们的分析表明，ACEI和/或ARB的使用与COVID-19的检测阳性率和COVID-19患者的死亡率均无关。
Some have hypothesized that the use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) may modify susceptibility to coronavirus disease-2019 (COVID-19) in humans. Thus, we conducted two meta-analyses to investigate the effect of ACEI and ARB on mortality and susceptibility to COVID-19. Pubmed and EMBASE were searched through June 2020 to identify clinical trials that investigated the testing positive and in-hospital mortality rates for COVID-19 for those who were treated with ACEI and/or ARB and for those who were not treated with ACEI or ARB. The first analysis investigated the testing positive rate of COVID-19. The second analysis investigated the in-hospital mortality rate for patients with COVID-19. Three eligible studies for the first analysis and 14 eligible studies for the second analysis were identified. The first analysis demonstrated that the use of ACEI or ARB did not affect the testing positive rates (odds ratio [OR] [confidence interval [CI]] = 0.96 [0.88-1.04]; p = .69, OR [CI] = 0.99 [0.91-1.08]; p = 0.35, respectively). The second analysis showed that the use of ACEI and/or ARB did not affect in-hospital mortality (risk ratio [RR] 95% [CI]] = 0.88 [0.64-1.20], p = 0.42). The subgroup analysis by limiting studies of patients with hypertension showed ACEI and/or ARB use was associated with a significant reduction of in-hospital mortality compared with no ACEI or ARB use (RR [CI] = 0.66 [0.49-0.89], p = 0.004). Our analysis demonstrated that ACEI and/or ARB use was associated neither with testing positive rates of COVID-19 nor with mortality of COVID-19 patients.