A systematic review and meta-analysis of the use of renin-angiotensin system drugs and COVID-19 clinical outcomes: What is the evidence so far?
A systematic review and meta-analysis of the use of renin-angiotensin system drugs and COVID-19 clinical outcomes: What is the evidence so far?
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DOI：
10.1002/prp2.666
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发表时间：
2020-12
影响因子：
2.6
通讯作者：
Godman B
中科院分区：
文献类型：
--
作者：
Kurdi A;Abutheraa N;Akil L;Godman B
有证据表明血管紧张素转换酶抑制剂（ACEIs）/血管紧张素受体阻滞剂（ARB）对COVID-19临床结局的影响。我们的目的是使用Medline（奥维德）、Embase、Scopus、科克伦图书馆和medRxiv中进行的系统性综述/Meta分析方法，对ACEI/ARB对COVID-19相关临床结局的影响进行全面/更新评价，包括探索ACEI和ARB之间的类间差异。纳入了评价ACEI/ARB在COVID-19患者中的作用的英文研究。采用纽卡斯尔-渥太华量表评价研究质量。使用按暴露（ACEI/ARB、ACEI和ARB）分层的随机效应模型分析数据。使用I2统计量评估异质性。进行了几项亚组分析，以探索潜在混杂因素的影响。总共有27项研究合格。汇总分析显示，ACEIs/ARB与死亡（OR：0.97; 95%CI：0.75，1.27）、ICU入院（OR：1.09;95%CI：0.65，1.81）、死亡/ICU入院（OR：0.67; 95%CI：0.52，0.86）、COVID-19感染风险（OR：1.01; 95%CI：0.93，1.10）、重度感染（OR：0.78; 95%CI：0.53，1.15）和住院（OR：1.15; 95%CI：0.81，1.65）之间无显著相关性。然而，亚组分析表明，在美国研究（OR：1.59; 95%CI：1.03，2.44）、同行评议（OR：1.93，95%CI：1.38，2.71）、质量良好和报告了校正后疗效指标的研究（OR：1.30，95%CI：1.10，1.50）中，ACEIs/ARB与住院之间存在显著相关性。ACEI和ARB之间存在显着差异，后者与降低COVID-19感染风险显着相关（OR：0.24; 95%CI：0.17，0.34）。总之，ACEI/ARB对某些COVID-19临床结局的影响存在高质量的证据。我们首次提供了关于ACEI和ARB在某些报告的临床结局方面存在类间差异的证据，尽管证据质量较低。
Conflicting evidence exists about the effect of angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) on COVID‐19 clinical outcomes. We aimed to provide a comprehensive/updated evaluation of the effect of ACEIs/ARBs on COVID‐19‐related clinical outcomes, including exploration of interclass differences between ACEIs and ARBs, using a systematic review/meta‐analysis approach conducted in Medline (OVID), Embase, Scopus, Cochrane library, and medRxiv from inception to 22 May 2020. English studies that evaluated the effect of ACEIs/ARBs among patients with COVID‐19 were included. Studies’ quality was appraised using the Newcastle‐Ottawa Scale. Data were analyzed using the random‐effects modeling stratified by exposure (ACEIs/ARBs, ACEIs, and ARBs). Heterogeneiity was assessed using I2 statistic. Several subgroup analyses were conducted to explore the impact of potential confounders. Overall, 27 studies were eligible. The pooled analyses showed nonsignificant associations between ACEIs/ARBs and death (OR:0.97, 95%CI:0.75,1.27), ICU admission (OR:1.09;95%CI:0.65,1.81), death/ICU admission (OR:0.67; 95%CI:0.52,0.86), risk of COVID‐19 infection (OR:1.01; 95%CI:0.93,1.10), severe infection (OR:0.78; 95%CI:0.53,1.15), and hospitalization (OR:1.15; 95%CI:0.81,1.65). However, the subgroup analyses indicated significant association between ACEIs/ARBs and hospitalization among USA studies (OR:1.59; 95%CI:1.03,2.44), peer‐reviewed (OR:1.93, 95%CI:1.38,2.71), good quality and studies which reported adjusted measure of effect (OR:1.30, 95%CI:1.10,1.50). Significant differences were found between ACEIs and ARBs with the latter being significantly associated with lower risk of acquiring COVID‐19 infection (OR:0.24; 95%CI: 0.17,0.34). In conclusion, high‐quality evidence exists for the effect of ACEIs/ARBs on some COVID‐19 clinical outcomes. For the first time, we provided evidence, albeit of low quality, on interclass differences between ACEIs and ARBs for some of the reported clinical outcomes.
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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：
3.3
作者：
Abena, Pascale M.;Decloedt, Eric H.;Nachega, Jean B.
通讯作者：
Nachega, Jean B.
DOI：
10.1007/s40271-017-0291-3
发表时间：
2018-08
期刊：
The patient
影响因子：
--
作者：
Almeida PHRF;Silva TBC;de Assis Acurcio F;Guerra Júnior AA;Araújo VE;Diniz LM;Godman B;Almeida AM;Alvares J
通讯作者：
Alvares J
影响因子：
105.7
作者：
Higgins, JPT;Thompson, SG;Altman, DG
通讯作者：
Altman, DG
影响因子：
4.9
作者：
Esler, Murray;Esler, Danielle
通讯作者：
Esler, Danielle