Cargando…

An umbrella review and meta‐analysis of renin–angiotensin system drugs use and COVID‐19 outcomes

BACKGROUND: Despite the availability of extensive literature on the effect of angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin‐receptor blockers (ARBs) on COVID‐19 outcomes, the evidence is still controversial. We aimed to provide a comprehensive assessment of the effect of ACEIs/ARBs on...

Descripción completa

Detalles Bibliográficos
Autores principales: Kurdi, Amanj, Mueller, Tanja, Weir, Natalie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9874890/
https://www.ncbi.nlm.nih.gov/pubmed/36205627
http://dx.doi.org/10.1111/eci.13888
_version_ 1784877845250572288
author Kurdi, Amanj
Mueller, Tanja
Weir, Natalie
author_facet Kurdi, Amanj
Mueller, Tanja
Weir, Natalie
author_sort Kurdi, Amanj
collection PubMed
description BACKGROUND: Despite the availability of extensive literature on the effect of angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin‐receptor blockers (ARBs) on COVID‐19 outcomes, the evidence is still controversial. We aimed to provide a comprehensive assessment of the effect of ACEIs/ARBs on COVID‐19‐related outcomes by summarising the currently available evidence. METHODS: An umbrella review was conducted using Medline (OVID), Embase, Scopus, Cochrane library and medRxiv from inception to 1 February 2021. Systematic reviews with meta‐analysis that evaluated the effect of ACEIs/ARBs on COVID‐19‐related clinical outcomes were eligible. Studies' quality was appraised using the AMSTAR 2 Critical Appraisal Tool. Data were analysed using the random‐effects modelling including several subgroup analyses. Heterogenicity was assessed using I(2) statistic. The study protocol was registered in PROSPERO (CRD42021233398) and reported using PRISMA guidelines. RESULTS: Overall, 47 reviews were eligible for inclusion. Out of the nine COVID‐19 outcomes evaluated, there was significant associations between ACEIs/ARBs use and each of death (OR = 0.80, 95%CI = 0.75–0.86; I(2) = 51.9%), death/ICU admission as composite outcome (OR = 0.86, 95%CI = 0.80–0.92; I(2) = 43.9%), severe COVID‐19 (OR = 0.86, 95%CI = 0.78–0.95; I(2) = 68%) and hospitalisation (OR = 1.23, 95%CI = 1.04–1.46; I(2) = 76.4%). The significant reduction in death/ICU admission, however, was higher among studies which presented adjusted measure of effects (OR = 0.63, 95%CI = 0.47–0.84) and were of moderate quality (OR = 0.74, 95%CI = 0.63–0.85). CONCLUSIONS: Collective evidence from observational studies indicate a good quality evidence on the significant association between ACEIs/ARBs use and reduction in death and death/ICU admission, but poor‐quality evidence on both reducing severe COVID‐19 and increasing hospitalisation. Our findings further support the current recommendations of not discontinuing ACEIs/ARBs therapy in patients with COVID‐19.
format Online
Article
Text
id pubmed-9874890
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-98748902023-01-25 An umbrella review and meta‐analysis of renin–angiotensin system drugs use and COVID‐19 outcomes Kurdi, Amanj Mueller, Tanja Weir, Natalie Eur J Clin Invest Meta‐analysis BACKGROUND: Despite the availability of extensive literature on the effect of angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin‐receptor blockers (ARBs) on COVID‐19 outcomes, the evidence is still controversial. We aimed to provide a comprehensive assessment of the effect of ACEIs/ARBs on COVID‐19‐related outcomes by summarising the currently available evidence. METHODS: An umbrella review was conducted using Medline (OVID), Embase, Scopus, Cochrane library and medRxiv from inception to 1 February 2021. Systematic reviews with meta‐analysis that evaluated the effect of ACEIs/ARBs on COVID‐19‐related clinical outcomes were eligible. Studies' quality was appraised using the AMSTAR 2 Critical Appraisal Tool. Data were analysed using the random‐effects modelling including several subgroup analyses. Heterogenicity was assessed using I(2) statistic. The study protocol was registered in PROSPERO (CRD42021233398) and reported using PRISMA guidelines. RESULTS: Overall, 47 reviews were eligible for inclusion. Out of the nine COVID‐19 outcomes evaluated, there was significant associations between ACEIs/ARBs use and each of death (OR = 0.80, 95%CI = 0.75–0.86; I(2) = 51.9%), death/ICU admission as composite outcome (OR = 0.86, 95%CI = 0.80–0.92; I(2) = 43.9%), severe COVID‐19 (OR = 0.86, 95%CI = 0.78–0.95; I(2) = 68%) and hospitalisation (OR = 1.23, 95%CI = 1.04–1.46; I(2) = 76.4%). The significant reduction in death/ICU admission, however, was higher among studies which presented adjusted measure of effects (OR = 0.63, 95%CI = 0.47–0.84) and were of moderate quality (OR = 0.74, 95%CI = 0.63–0.85). CONCLUSIONS: Collective evidence from observational studies indicate a good quality evidence on the significant association between ACEIs/ARBs use and reduction in death and death/ICU admission, but poor‐quality evidence on both reducing severe COVID‐19 and increasing hospitalisation. Our findings further support the current recommendations of not discontinuing ACEIs/ARBs therapy in patients with COVID‐19. John Wiley and Sons Inc. 2022-10-19 2023-02 /pmc/articles/PMC9874890/ /pubmed/36205627 http://dx.doi.org/10.1111/eci.13888 Text en © 2022 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Meta‐analysis
Kurdi, Amanj
Mueller, Tanja
Weir, Natalie
An umbrella review and meta‐analysis of renin–angiotensin system drugs use and COVID‐19 outcomes
title An umbrella review and meta‐analysis of renin–angiotensin system drugs use and COVID‐19 outcomes
title_full An umbrella review and meta‐analysis of renin–angiotensin system drugs use and COVID‐19 outcomes
title_fullStr An umbrella review and meta‐analysis of renin–angiotensin system drugs use and COVID‐19 outcomes
title_full_unstemmed An umbrella review and meta‐analysis of renin–angiotensin system drugs use and COVID‐19 outcomes
title_short An umbrella review and meta‐analysis of renin–angiotensin system drugs use and COVID‐19 outcomes
title_sort umbrella review and meta‐analysis of renin–angiotensin system drugs use and covid‐19 outcomes
topic Meta‐analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9874890/
https://www.ncbi.nlm.nih.gov/pubmed/36205627
http://dx.doi.org/10.1111/eci.13888
work_keys_str_mv AT kurdiamanj anumbrellareviewandmetaanalysisofreninangiotensinsystemdrugsuseandcovid19outcomes
AT muellertanja anumbrellareviewandmetaanalysisofreninangiotensinsystemdrugsuseandcovid19outcomes
AT weirnatalie anumbrellareviewandmetaanalysisofreninangiotensinsystemdrugsuseandcovid19outcomes
AT kurdiamanj umbrellareviewandmetaanalysisofreninangiotensinsystemdrugsuseandcovid19outcomes
AT muellertanja umbrellareviewandmetaanalysisofreninangiotensinsystemdrugsuseandcovid19outcomes
AT weirnatalie umbrellareviewandmetaanalysisofreninangiotensinsystemdrugsuseandcovid19outcomes