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Impact of Chronic RAAS Use in Elderly COVID-19 Patients: A Retrospective Analysis

Corona Virus Disease-19 (COVID-19) recently emerged as a global pandemic. Advanced age is the most important risk factor for increased virus susceptibility and worse outcomes. Many older adults are currently treated with renin–angiotensin–aldosterone system (RAAS) inhibitors and there is concern tha...

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Autores principales: Oliveira, João, Gameiro, Joana, Bernardo, João, Marques, Filipe, Costa, Cláudia, Branco, Carolina, Duarte, Inês, Fonseca, José, Carreiro, Carolina, Braz, Sandra, Lopes, José António
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307646/
https://www.ncbi.nlm.nih.gov/pubmed/34300311
http://dx.doi.org/10.3390/jcm10143147
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author Oliveira, João
Gameiro, Joana
Bernardo, João
Marques, Filipe
Costa, Cláudia
Branco, Carolina
Duarte, Inês
Fonseca, José
Carreiro, Carolina
Braz, Sandra
Lopes, José António
author_facet Oliveira, João
Gameiro, Joana
Bernardo, João
Marques, Filipe
Costa, Cláudia
Branco, Carolina
Duarte, Inês
Fonseca, José
Carreiro, Carolina
Braz, Sandra
Lopes, José António
author_sort Oliveira, João
collection PubMed
description Corona Virus Disease-19 (COVID-19) recently emerged as a global pandemic. Advanced age is the most important risk factor for increased virus susceptibility and worse outcomes. Many older adults are currently treated with renin–angiotensin–aldosterone system (RAAS) inhibitors and there is concern that these medications might increase the risk of mortality by COVID-19. This is a retrospective cohort of 346 patients older than 65 years with COVID-19, at the Department of Medicine of the Centro Hospitalar Universitário Lisboa Norte, in Portugal, hospitalized between March 2020 and August 2020. Mean age was 80.9 ± 8.7 years old. Most patients had arterial hypertension (n = 279, 80.6%), almost half (n = 161, 46.5%) had cardiovascular disease and approximately one-third of patients had heart failure (n = 127, 36.7%) or diabetes Mellitus (n = 113, 32.7%). Ninety-eight patients (28.3%) had chronic kidney disease and almost half of the patients (49.4%) were chronically under renin–angiotensin–aldosterone system (RAAS) inhibitors. Twenty percent of patients died during hospitalization. In a multivariate analysis, older age (OR 1.11, 95% CI 1.04, 1.18, p = 0.002), absence of baseline medication with RAAS inhibitors (OR 0.27, 95% CI 0.10, 0.75, p = 0.011), higher serum ferritin (OR 1.00, 95% CI 1.00, 1.00, p = 0.003) and higher lactate levels (OR 1.08, 95% CI 1.02, 1.14, p = 0.006) were independent predictors of mortality. Older age, higher serum ferritin and lactate levels at admission were found to be independent predictors of mortality and might act as early predictors of worsening disease in clinical practice. Chronic treatment with RAAS inhibitors appeared to be protective, supporting guidelines in not discontinuing such drugs.
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spelling pubmed-83076462021-07-25 Impact of Chronic RAAS Use in Elderly COVID-19 Patients: A Retrospective Analysis Oliveira, João Gameiro, Joana Bernardo, João Marques, Filipe Costa, Cláudia Branco, Carolina Duarte, Inês Fonseca, José Carreiro, Carolina Braz, Sandra Lopes, José António J Clin Med Article Corona Virus Disease-19 (COVID-19) recently emerged as a global pandemic. Advanced age is the most important risk factor for increased virus susceptibility and worse outcomes. Many older adults are currently treated with renin–angiotensin–aldosterone system (RAAS) inhibitors and there is concern that these medications might increase the risk of mortality by COVID-19. This is a retrospective cohort of 346 patients older than 65 years with COVID-19, at the Department of Medicine of the Centro Hospitalar Universitário Lisboa Norte, in Portugal, hospitalized between March 2020 and August 2020. Mean age was 80.9 ± 8.7 years old. Most patients had arterial hypertension (n = 279, 80.6%), almost half (n = 161, 46.5%) had cardiovascular disease and approximately one-third of patients had heart failure (n = 127, 36.7%) or diabetes Mellitus (n = 113, 32.7%). Ninety-eight patients (28.3%) had chronic kidney disease and almost half of the patients (49.4%) were chronically under renin–angiotensin–aldosterone system (RAAS) inhibitors. Twenty percent of patients died during hospitalization. In a multivariate analysis, older age (OR 1.11, 95% CI 1.04, 1.18, p = 0.002), absence of baseline medication with RAAS inhibitors (OR 0.27, 95% CI 0.10, 0.75, p = 0.011), higher serum ferritin (OR 1.00, 95% CI 1.00, 1.00, p = 0.003) and higher lactate levels (OR 1.08, 95% CI 1.02, 1.14, p = 0.006) were independent predictors of mortality. Older age, higher serum ferritin and lactate levels at admission were found to be independent predictors of mortality and might act as early predictors of worsening disease in clinical practice. Chronic treatment with RAAS inhibitors appeared to be protective, supporting guidelines in not discontinuing such drugs. MDPI 2021-07-16 /pmc/articles/PMC8307646/ /pubmed/34300311 http://dx.doi.org/10.3390/jcm10143147 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Oliveira, João
Gameiro, Joana
Bernardo, João
Marques, Filipe
Costa, Cláudia
Branco, Carolina
Duarte, Inês
Fonseca, José
Carreiro, Carolina
Braz, Sandra
Lopes, José António
Impact of Chronic RAAS Use in Elderly COVID-19 Patients: A Retrospective Analysis
title Impact of Chronic RAAS Use in Elderly COVID-19 Patients: A Retrospective Analysis
title_full Impact of Chronic RAAS Use in Elderly COVID-19 Patients: A Retrospective Analysis
title_fullStr Impact of Chronic RAAS Use in Elderly COVID-19 Patients: A Retrospective Analysis
title_full_unstemmed Impact of Chronic RAAS Use in Elderly COVID-19 Patients: A Retrospective Analysis
title_short Impact of Chronic RAAS Use in Elderly COVID-19 Patients: A Retrospective Analysis
title_sort impact of chronic raas use in elderly covid-19 patients: a retrospective analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307646/
https://www.ncbi.nlm.nih.gov/pubmed/34300311
http://dx.doi.org/10.3390/jcm10143147
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