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Adverse impact of renin–angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study
The association between angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) and the risk of mortality in hospitalized patients with severe coronavirus disease 2019 (COVID-19) was investigated. This retrospective cohort study was performed in all hospitalized pati...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680105/ https://www.ncbi.nlm.nih.gov/pubmed/33219294 http://dx.doi.org/10.1038/s41598-020-76915-4 |
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author | Lim, Jeong-Hoon Cho, Jang-Hee Jeon, Yena Kim, Ji Hye Lee, Ga Young Jeon, Soojee Noh, Hee Won Lee, Yong-Hoon Lee, Jaehee Chang, Hyun-Ha Jung, Hee-Yeon Choi, Ji-Young Park, Sun-Hee Kim, Chan-Duck Kim, Yong-Lim Kim, Shin-Woo |
author_facet | Lim, Jeong-Hoon Cho, Jang-Hee Jeon, Yena Kim, Ji Hye Lee, Ga Young Jeon, Soojee Noh, Hee Won Lee, Yong-Hoon Lee, Jaehee Chang, Hyun-Ha Jung, Hee-Yeon Choi, Ji-Young Park, Sun-Hee Kim, Chan-Duck Kim, Yong-Lim Kim, Shin-Woo |
author_sort | Lim, Jeong-Hoon |
collection | PubMed |
description | The association between angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) and the risk of mortality in hospitalized patients with severe coronavirus disease 2019 (COVID-19) was investigated. This retrospective cohort study was performed in all hospitalized patients with COVID-19 in tertiary hospitals in Daegu, Korea. Patients were classified based on whether they received ACE-I or ARB before COVID-19 diagnosis. The analysis of the primary outcome, in-hospital mortality, was performed using the Cox proportional hazards regression model. Of 130 patients with COVID-19, 30 (23.1%) who received ACE-I or ARB exhibited an increased risk of in-hospital mortality (adjusted hazard ratio, 2.20; 95% confidence interval [CI], 1.10–4.38; P = 0.025). ACE-I or ARB was also associated with severe complications, such as acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR], 2.58; 95% CI, 1.02–6.51; P = 0.045) and acute kidney injury (AKI) (aOR, 3.06; 95% CI, 1.15–8.15; P = 0.026). Among the patients with ACE-I or ARB therapy, 8 patients (26.7%) used high equivalent doses of ACE-I or ARB and they had higher in-hospital mortality and an increased risk of ARDS and AKI (all, P < 0.05). ACE-I or ARB therapy in patients with severe COVID-19 was associated with the occurrence of severe complications and increased in-hospital mortality. The potentially harmful effect of ACE-I or ARB therapy may be higher in patients who received high doses. |
format | Online Article Text |
id | pubmed-7680105 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-76801052020-11-24 Adverse impact of renin–angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study Lim, Jeong-Hoon Cho, Jang-Hee Jeon, Yena Kim, Ji Hye Lee, Ga Young Jeon, Soojee Noh, Hee Won Lee, Yong-Hoon Lee, Jaehee Chang, Hyun-Ha Jung, Hee-Yeon Choi, Ji-Young Park, Sun-Hee Kim, Chan-Duck Kim, Yong-Lim Kim, Shin-Woo Sci Rep Article The association between angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) and the risk of mortality in hospitalized patients with severe coronavirus disease 2019 (COVID-19) was investigated. This retrospective cohort study was performed in all hospitalized patients with COVID-19 in tertiary hospitals in Daegu, Korea. Patients were classified based on whether they received ACE-I or ARB before COVID-19 diagnosis. The analysis of the primary outcome, in-hospital mortality, was performed using the Cox proportional hazards regression model. Of 130 patients with COVID-19, 30 (23.1%) who received ACE-I or ARB exhibited an increased risk of in-hospital mortality (adjusted hazard ratio, 2.20; 95% confidence interval [CI], 1.10–4.38; P = 0.025). ACE-I or ARB was also associated with severe complications, such as acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR], 2.58; 95% CI, 1.02–6.51; P = 0.045) and acute kidney injury (AKI) (aOR, 3.06; 95% CI, 1.15–8.15; P = 0.026). Among the patients with ACE-I or ARB therapy, 8 patients (26.7%) used high equivalent doses of ACE-I or ARB and they had higher in-hospital mortality and an increased risk of ARDS and AKI (all, P < 0.05). ACE-I or ARB therapy in patients with severe COVID-19 was associated with the occurrence of severe complications and increased in-hospital mortality. The potentially harmful effect of ACE-I or ARB therapy may be higher in patients who received high doses. Nature Publishing Group UK 2020-11-20 /pmc/articles/PMC7680105/ /pubmed/33219294 http://dx.doi.org/10.1038/s41598-020-76915-4 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Article Lim, Jeong-Hoon Cho, Jang-Hee Jeon, Yena Kim, Ji Hye Lee, Ga Young Jeon, Soojee Noh, Hee Won Lee, Yong-Hoon Lee, Jaehee Chang, Hyun-Ha Jung, Hee-Yeon Choi, Ji-Young Park, Sun-Hee Kim, Chan-Duck Kim, Yong-Lim Kim, Shin-Woo Adverse impact of renin–angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study |
title | Adverse impact of renin–angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study |
title_full | Adverse impact of renin–angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study |
title_fullStr | Adverse impact of renin–angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study |
title_full_unstemmed | Adverse impact of renin–angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study |
title_short | Adverse impact of renin–angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study |
title_sort | adverse impact of renin–angiotensin system blockade on the clinical course in hospitalized patients with severe covid-19: a retrospective cohort study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680105/ https://www.ncbi.nlm.nih.gov/pubmed/33219294 http://dx.doi.org/10.1038/s41598-020-76915-4 |
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