Outcomes of COVID-19 Hospitalized Patients Previously Treated with Renin-Angiotensin System Inhibitors.
Outcomes of COVID-19 Hospitalized Patients Previously Treated with Renin-Angiotensin System Inhibitors.
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DOI：
10.3390/jcm9113472
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发表时间：
2020-10-28
影响因子：
3.9
通讯作者：
Stephan D
中科院分区：
文献类型：
--
作者：
Cordeanu EM;Jambert L;Severac F;Lambach H;Tousch J;Heitz M;Mirea C;Hamadé A;Younes W;Frantz AS;Merdji H;Schini-Kerth V;Bilbault P;Meziani F;Ohlmann P;Andres E;Stephan D
(1) 背景：严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 通过血管紧张素转换酶 2 结合穿透呼吸道上皮，引起人们对肾素-血管紧张素系统抑制剂 (RASi) 对人类冠状病毒病 2019 (COVID-19) 进化的潜在有害影响的担忧。本研究旨在深入了解 RASi 对因 COVID-19 住院患者的 SARS-CoV-2 结局的影响。 (2) 方法：这是对法国一所大学医院收治的 SARS-CoV-2 感染成人住院患者的回顾性分析。观察期于出院时结束。 (3) 结果：研究期间，我机构收治了 943 名 COVID-19 患者，其中 772 名患者纳入本次分析。其中，431人（55.8%）既往患有高血压。中位年龄为 68 (56–79) 岁。总体而言，220 名患者（28.5%）接受机械通气，其中 173 名患者（22.4%）死亡。根据之前接触 RASi 的情况，我们定义了两组，即“RASi”（n = 282）和“RASi-free”（n = 490）。接受 RASi 治疗的患者中，严重肺炎（定义为导致死亡和/或需要插管、高流量鼻吸氧、无创通气和/或氧流量≥5 L/min）和死亡的发生率更高（分别为 64% vs 53% 和 29% vs 19%）。然而，在来自总体人群的倾向评分匹配队列中，死亡（风险比（HR）0.93（95%置信区间（CI）0.57-1.50），p = 0.76）和严重肺炎（HR 1.03（95%CI 0.73-1.44），p = 0.85）均与RASi治疗无关。 (4) 结论：我们的研究显示，在调整混杂因素后，既往 RASi 治疗与死亡或严重 COVID-19 肺炎之间没有相关性。
(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates respiratory epithelium through angiotensin-converting enzyme-2 binding, raising concerns about the potentially harmful effects of renin–angiotensin system inhibitors (RASi) on Human Coronavirus Disease 2019 (COVID-19) evolution. This study aimed to provide insight into the impact of RASi on SARS-CoV-2 outcomes in patients hospitalized for COVID-19. (2) Methods: This was a retrospective analysis of hospitalized adult patients with SARS-CoV-2 infection admitted to a university hospital in France. The observation period ended at hospital discharge. (3) Results: During the study period, 943 COVID-19 patients were admitted to our institution, of whom 772 were included in this analysis. Among them, 431 (55.8%) had previously known hypertension. The median age was 68 (56–79) years. Overall, 220 (28.5%) patients were placed under mechanical ventilation and 173 (22.4%) died. According to previous exposure to RASi, we defined two groups, namely, “RASi” (n = 282) and “RASi-free” (n = 490). Severe pneumonia (defined as leading to death and/or requiring intubation, high-flow nasal oxygen, noninvasive ventilation, and/or oxygen flow at a rate of ≥5 L/min) and death occurred more frequently in RASi-treated patients (64% versus 53% and 29% versus 19%, respectively). However, in a propensity score-matched cohort derived from the overall population, neither death (hazard ratio (HR) 0.93 (95% confidence interval (CI) 0.57–1.50), p = 0.76) nor severe pneumonia (HR 1.03 (95%CI 0.73–1.44), p = 0.85) were associated with RASi therapy. (4) Conclusion: Our study showed no correlation between previous RASi treatment and death or severe COVID-19 pneumonia after adjustment for confounders.