Renin-angiotensin-aldosterone system blockers and region-specific variations in COVID-19 outcomes: findings from a systematic review and meta-analysis.
Renin-angiotensin-aldosterone system blockers and region-specific variations in COVID-19 outcomes: findings from a systematic review and meta-analysis.
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肾素 - 血管紧张素 - 醛固酮系统阻滞剂和COVID-19结果中的区域特异性变化：来自系统的综述和荟萃分析的结果。
DOI：
10.1177/20420986211011345
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发表时间：
2021
影响因子：
4.4
通讯作者：
Patel TK
中科院分区：
文献类型：
--
作者：
Kaur U;Chakrabarti SS;Patel TK
冠状病毒病2019(新冠肺炎)被观察到会导致心脏代谢性疾病患者的高死亡率。肾素-血管紧张素-醛固酮系统(RAAS)阻滞剂可增强SARS-CoV-2的结合受体ACE2的表达，从而增强病毒的感染性。我们的目标是提供RAAS阻滞剂对新冠肺炎预后影响的综合估计。使用MEDLINE/PubMed、Google Scholar和Preprint服务器进行文献搜索。所有分析RAAS阻滞剂对新冠肺炎患者临床结局影响的临床研究均纳入本研究。采用纽卡斯尔-渥太华量表对研究进行质量评价。遵循了驼鹿的检查表。死亡率和严重程度结果被记录为具有95%可信区间(CI)和异质性水平(I2)的合并优势比(OR)。死亡几率是主要结果。严重程度、住院、重症监护病房(ICU)入院、机械通气(MV)、使用类固醇和急性肾损伤的几率是次要结果。严重程度结果的选择取决于各自作者所使用的定义。还探讨了RAAS阻滞剂的个别类别的特定国家的变异和影响。共有47项已发表的研究进入最终分析，死亡分析中的31项研究中共有26,432名患者，严重性分析中的23项研究中共有20,127名患者。使用RAAS阻滞剂未见死亡风险[合并OR0.91(0.65-1.26)，I2 = 89%]或严重程度[合并OR1.08(0.79-1.46)，I2RAS 88%]增加。该类药物对高血压具有保护作用[合并OR0.63(0.46~0.86)，I2 = 58%]。对于欧洲患者[合并OR2.08(1.5-2.85)，I2 = 77%]和美国患者[合并OR1.87(1.62-2.17)]，新冠肺炎预后的严重性较高。在美国患者中，住院风险增加了近4 倍，入院和机械通气风险增加了2 倍。按类别划分，血管紧张素受体阻滞剂的使用与严重风险增加1.6倍相关，主要是在欧洲人。RAAS阻滞剂与新冠肺炎患者死亡率增加无关，应继续用于高血压患者。美国和欧洲的患者出现严重后果的风险更高。药物遗传差异可能解释了种族相关的差异。RAAS拮抗剂对新冠肺炎的影响背景和目的：观察到患有其他长期疾病如心脏病、糖尿病和高血压的新冠肺炎患者死亡率较高。这些患者中的许多人都开了一种名为RAAS阻滞剂(雷米普利、替米沙坦等)的药物。我们研究了这些药物的使用是否会恶化这些患者的新冠肺炎病程或导致额外的死亡。方法：对47篇关于新冠肺炎患者RAAS受体阻滞剂使用情况的观察性研究进行汇总分析。结果：我们发现RAAS阻滞剂不会导致新冠肺炎患者的额外死亡。相反，如果给高血压患者开处方，它们是有好处的。我们还发现，尽管服用这些药物的欧洲和美国新冠肺炎患者的疾病严重程度更高，但中国患者的情况并非如此。结论：种族差异可能与遗传等因素有关。
Coronavirus disease 2019 (COVID-19) has been observed to cause a high mortality in people with cardiometabolic diseases. Renin–angiotensin–aldosterone system (RAAS) blockers enhance the expression of ACE2, the binding receptor of SARS-CoV-2, and can enhance viral infectivity. We aim to provide a pooled estimate of the effect of RAAS blockers on COVID-19 outcomes. A literature search was performed using MEDLINE/PubMed, Google Scholar and preprint servers. All clinical studies analyzing the effect of RAAS blockers on clinical outcomes in COVID-19 patients were included in this study. Newcastle–Ottawa scale was used for quality assessment of studies. MOOSE checklist was followed. Mortality and severity outcomes were recorded as pooled odds ratio (OR) with 95% Confidence Intervals (CIs) and level of heterogeneity (I2). Odds of mortality was the primary outcome. Odds of severity, hospitalization, intensive care unit (ICU) admission, mechanical ventilation (MV), steroid use and acute kidney injury were the secondary outcomes. Severity outcomes were chosen depending upon the definition used by respective authors. Country-specific variations and effects of individual class of RAAS blockers were also explored. In total 47 published studies were included in the final analysis, with a total of 26,432 patients from 31 studies in mortality analysis and 20,127 patients from 23 studies in severity analysis. No increased risk of mortality [Pooled OR 0.91 (0.65–1.26), I2 = 89%] or severity [Pooled OR 1.08 (0.79–1.46), I2 = 88%] was seen with RAAS blockers. The drug class was protective in hypertension [pooled OR 0.63 (0.46–0.86), I2 = 58%]. Severity of COVID-19 outcomes was high for Europeans [Pooled OR 2.08 (1.52–2.85), I2 = 77%] and US patients [Pooled OR 1.87 (1.62–2.17)]. Nearly 4 times higher risk of hospitalization and 2 times higher risk of ICU admission and MV were observed in US patients. Class-wise, angiotensin receptor blocker use was associated with 1.6 times higher odds of severity, mainly in Europeans. RAAS blockers are not associated with increased mortality in COVID-19 patients and should be continued in hypertensives. US and European patients are at higher risk of severe outcomes. Pharmacogenetic differences may explain the ethnicity-related variations. Effect of RAAS-blocking medicines on COVID-19 Background and aims: Higher deaths have been observed in COVID-19 patients who have other long-term diseases such as heart disease, diabetes, and high blood pressure. Many of these patients are prescribed a class of medicines called RAAS blockers (ramipril, telmisartan, etc). We studied whether the use of these medicines worsens the course of COVID-19 disease in these patients or causes excess deaths. Methods: We conducted a pooled analysis of 47 observational studies on the use of RAAS blocker drugs in COVID-19 patients. Results: We found that RAAS blockers do not cause excess deaths in patients with COVID-19. On the contrary, they have benefits if prescribed to those with high blood pressure. We also found that whereas European and US patients of COVID-19 taking these medicines had higher disease severity, this was not the case for Chinese patients. Conclusion: Theremay be some genetic and other factors responsible for differences by ethnicity.
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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：
4.6
作者：
Dai, Shuhong;Ding, Mei;Liu, Hongyu
通讯作者：
Liu, Hongyu
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：
3.2
作者：
Felice, Carla;Nardin, Chiara;Rattazzi, Marcello
通讯作者：
Rattazzi, Marcello
影响因子：
168.9
作者：
de Abajo, Francisco J.;Rodriguez-Martin, Sara;Rodriguez-Puyol, Diego
通讯作者：
Rodriguez-Puyol, Diego