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Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens

AIMS: This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs). METHODS AND RESULTS: All adults with SARS-CoV-...

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Autores principales: Bravi, Francesca, Flacco, Maria Elena, Carradori, Tiziano, Volta, Carlo Alberto, Cosenza, Giuseppe, De Togni, Aldo, Acuti Martellucci, Cecilia, Parruti, Giustino, Mantovani, Lorenzo, Manzoli, Lamberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314008/
https://www.ncbi.nlm.nih.gov/pubmed/32579597
http://dx.doi.org/10.1371/journal.pone.0235248
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author Bravi, Francesca
Flacco, Maria Elena
Carradori, Tiziano
Volta, Carlo Alberto
Cosenza, Giuseppe
De Togni, Aldo
Acuti Martellucci, Cecilia
Parruti, Giustino
Mantovani, Lorenzo
Manzoli, Lamberto
author_facet Bravi, Francesca
Flacco, Maria Elena
Carradori, Tiziano
Volta, Carlo Alberto
Cosenza, Giuseppe
De Togni, Aldo
Acuti Martellucci, Cecilia
Parruti, Giustino
Mantovani, Lorenzo
Manzoli, Lamberto
author_sort Bravi, Francesca
collection PubMed
description AIMS: This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs). METHODS AND RESULTS: All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50–1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40–2.23), diabetes (AOR: 1.52; 1.05–2.18), CVD (AOR: 1.88; 1.32–2.70) and COPD (AOR: 1.88; 1.11–3.20). Only gender, age and diabetes also predicted very severe/lethal disease. CONCLUSION: No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians.
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spelling pubmed-73140082020-06-29 Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens Bravi, Francesca Flacco, Maria Elena Carradori, Tiziano Volta, Carlo Alberto Cosenza, Giuseppe De Togni, Aldo Acuti Martellucci, Cecilia Parruti, Giustino Mantovani, Lorenzo Manzoli, Lamberto PLoS One Research Article AIMS: This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs). METHODS AND RESULTS: All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50–1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40–2.23), diabetes (AOR: 1.52; 1.05–2.18), CVD (AOR: 1.88; 1.32–2.70) and COPD (AOR: 1.88; 1.11–3.20). Only gender, age and diabetes also predicted very severe/lethal disease. CONCLUSION: No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians. Public Library of Science 2020-06-24 /pmc/articles/PMC7314008/ /pubmed/32579597 http://dx.doi.org/10.1371/journal.pone.0235248 Text en © 2020 Bravi et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Bravi, Francesca
Flacco, Maria Elena
Carradori, Tiziano
Volta, Carlo Alberto
Cosenza, Giuseppe
De Togni, Aldo
Acuti Martellucci, Cecilia
Parruti, Giustino
Mantovani, Lorenzo
Manzoli, Lamberto
Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens
title Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens
title_full Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens
title_fullStr Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens
title_full_unstemmed Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens
title_short Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens
title_sort predictors of severe or lethal covid-19, including angiotensin converting enzyme inhibitors and angiotensin ii receptor blockers, in a sample of infected italian citizens
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314008/
https://www.ncbi.nlm.nih.gov/pubmed/32579597
http://dx.doi.org/10.1371/journal.pone.0235248
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