Safety, tolerability, and outcomes of losartan use in patients hospitalized with SARS-CoV-2 infection: A feasibility study.
Safety, tolerability, and outcomes of losartan use in patients hospitalized with SARS-CoV-2 infection: A feasibility study.
复制标题
DOI：
10.1371/journal.pone.0244708
复制
发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Mallipattu SK
中科院分区：
文献类型：
--
作者：
Bolotova O;Yoo J;Chaudhri I;Marcos LA;Sahib H;Koraishy FM;Skopicki H;Ahmad S;Mallipattu SK
关于肾素-血管紧张素-醛固酮系统阻滞剂在2019年冠状病毒病(新冠肺炎)患者中使用的回顾性研究提供了大量信息，但存在矛盾，需要进行前瞻性研究来证明在住院的新冠肺炎和高血压患者中使用这些药物的安全性、耐受性和结果。这是一项单中心可行性研究，包括两个队列：(1)前瞻性队列(2020年4月21日至2020年5月29日)和(2)鼻咽拭子实时聚合酶链式反应(PCR)SARS-CoV-2阳性住院患者的回顾队列(2020年3月7日至2020年4月1日)。关键的入选标准包括BP>；130/80和要求补充氧的FiO2为25%或更高，以保持SpO2>；92%。主要排除标准包括登记时的高血钾和急性肾损伤(AKI)。前瞻性队列包括重新开始使用氯沙坦并持续至少7天，评估不良事件(AKI、高钾血症、转氨炎、低血压)和临床结果(SpO2/FiO2和炎症标志物的变化、是否需要ICU入院和机械通气)。回顾队列包括继续服用氯沙坦(入院前)和评估类似的结果。在前瞻性队列中，总共筛查了250名住院患者，其中16/250名患者符合纳入/排除标准；在回顾队列中，共有317名住院患者进行了筛查，14/317名患者符合纳入/排除标准。最常见的不良事件是低血压，导致前瞻性和回顾性队列中3/16(19%)和2/14(14%)的患者停药。与回顾队列中1/14(7%)需要停用氯沙坦的患者相比，前瞻性队列中没有患者发生AKI。前瞻性队列和回顾性队列中分别有1/16(6%)和0/14例患者发生高钾血症。在前瞻性队列中，3/16(19%)和2/16(13%)患者需要ICU入院和机械通气。相比之下，在回顾队列中，3/14(21%)需要ICU入院和机械通气。两个队列中的大多数患者(前瞻性和回顾性队列中的14/16(88%)和13/14(93%)患者)都活着出院了。共有9/16(前瞻性)和5/14(回顾性)患者完成了至少7天的氯沙坦治疗。在前瞻性队列中的这9名患者中，从第1天到第7天，SpO2/FiO2比率显著改善。两组患者的炎症标志物(起始、高峰和第7天)均未观察到显著变化。在这项先导性研究中，我们证明了氯沙坦在新冠肺炎和高血压住院患者中的耐受性良好。我们还证明了患者招募的可行性和评估氯沙坦开始或继续治疗的结果和安全性的适当参数，这为未来的随机临床试验提供了一个框架。
Retrospective studies on the use of Renin-Angiotensin-Aldosterone System blockade in patients with Coronavirus Disease 2019 (COVID-19) have been informative but conflicting, and prospective studies are required to demonstrate the safety, tolerability, and outcomes of initiating these agents in hospitalized patients with COVID-19 and hypertension. This is a single center feasibility study encompassing two cohorts: (1) prospective cohort (April 21, 2020 to May 29, 2020) and (2) retrospective cohort (March 7, 2020 to April 1, 2020) of hospitalized patients with real-time polymerase chain reaction (PCR) positive SARS-CoV-2 by nasopharyngeal swab. Key inclusion criteria include BP > 130/80 and a requirement of supplemental oxygen with FiO2 of 25% or higher to maintain SpO2 > 92%. Key exclusion criteria included hyperkalemia and acute kidney injury (AKI) at the time of enrollment. Prospective cohort consisted of de novo initiation of losartan and continuation for a minimum of 7 days and assessed for adverse events (AKI, hyperkalemia, transaminitis, hypotension) and clinical outcomes (change in SpO2/FiO2 and inflammatory markers, need for ICU admission and mechanical ventilation). Retrospective cohort consisted of continuation of losartan (prior-to-hospitalization) and assessment of similar outcomes. In the prospective cohort, a total of 250 hospitalized patients were screened and inclusion/exclusion criteria were met in 16/250 patients and in the retrospective cohort, a total of 317 hospitalized patients were screened and inclusion/exclusion criteria were met in 14/317 patients. Most common adverse event was hypotension, leading to discontinuation in 3/16 (19%) and 2/14 (14%) patients in the prospective and retrospective cohort. No patients developed AKI in the prospective cohort as compared to 1/14 (7%) patients in the retrospective cohort, requiring discontinuation of losartan. Hyperkalemia occurred in 1/16 (6%) and 0/14 patients in the prospective and retrospective cohorts, respectively. In the prospective cohort, 3/16 (19%) and 2/16 (13%) patients required ICU admission and mechanical ventilation. In comparison, 3/14 (21%) required ICU admission and mechanical ventilation in the retrospective cohort. A majority of patients in both cohorts (14/16 (88%) and 13/14 (93%) patients from the prospective and retrospective cohort) were discharged alive from the hospital. A total of 9/16 (prospective) and 5/14 (retrospective) patients completed a minimum 7 days of losartan. In these 9 patients in the prospective cohort, a significant improvement in SpO2/FiO2 ratio was observed from day 1 to 7. No significant changes in inflammatory markers (initiation, peak, and day 7) were observed in either cohort. In this pilot study we demonstrate that losartan was well-tolerated among hospitalized patients with COVID-19 and hypertension. We also demonstrate the feasibility of patient recruitment and the appropriate parameters to assess the outcomes and safety of losartan initiation or continuation, which provides a framework for future randomized clinical trials.
登录
查看更多内容
与住院的SARS-COV-2感染患者使用肾素 - 血管紧张素 - 醛固酮系统阻断有关的结果。
DOI：
10.34067/kid.0003792020
发表时间：
2020-08
期刊：
Kidney360
影响因子：
--
作者：
Chaudhri I;Koraishy FM;Bolotova O;Yoo J;Marcos LA;Taub E;Sahib H;Bloom M;Ahmad S;Skopicki H;Mallipattu SK
通讯作者：
Mallipattu SK
DOI：
10.1152/ajprenal.00616.2010
发表时间：
2011-03-01
影响因子：
4.2
作者：
Sabuhi, Rifat;Ali, Quaisar;Hussain, Tahir
通讯作者：
Hussain, Tahir
影响因子：
5.5
作者：
通讯作者：
--
影响因子：
120.7
作者：
Fosbol, Emil L.;Butt, Jawad H.;Kober, Lars
通讯作者：
Kober, Lars
影响因子：
158.5
作者：
Mancia, Giuseppe;Rea, Federico;Corrao, Giovanni
通讯作者：
Corrao, Giovanni