College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea.
Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Clin Infect Dis. 2020 Nov 19;71(16):2121-2128. doi: 10.1093/cid/ciaa624.
Renin-angiotensin-aldosterone system (RAAS) inhibitors may facilitate host cell entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or attenuate organ injury via RAAS blockade. We aimed to assess the associations between prior use of RAAS inhibitors and clinical outcomes among Korean patients with coronavirus disease 2019 (COVID-19).
We performed a nationwide population-based cohort study using the Korean Health Insurance Review and Assessment database. Claim records were screened for 69 793 individuals who were tested for COVID-19 until 8 April 2020. Adjusted odds ratios (ORs) were used to compare the clinical outcomes between RAAS inhibitor users and nonusers.
Among 5179 confirmed COVID-19 cases, 762 patients were RAAS inhibitor users and 4417 patients were nonusers. Relative to nonusers, RAAS inhibitor users were more likely to be older, male, and have comorbidities. Among 1954 hospitalized patients with COVID-19, 377 patients were RAAS inhibitor users, and 1577 patients were nonusers. In-hospital mortality was observed for 33 RAAS inhibitor users (9%) and 51 nonusers (3%) (P < .001). However, after adjustment for age, sex, Charlson comorbidity index, immunosuppression, and hospital type, the use of RAAS inhibitors was not associated with a higher risk of mortality (adjusted OR, 0.88; 95% confidence interval, 0.53-1.44; P = .60). No significant differences were observed between RAAS inhibitor users and nonusers in terms of vasopressor use, modes of ventilation, extracorporeal membrane oxygenation, renal replacement therapy, and acute cardiac events.
Our findings suggest that prior use of RAAS inhibitors was not independently associated with mortality among COVID-19 patients in Korea.
肾素-血管紧张素-醛固酮系统（RAAS）抑制剂可能通过 RAAS 阻断促进严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）进入宿主细胞，或减轻器官损伤。我们旨在评估韩国 2019 冠状病毒病（COVID-19）患者中 RAAS 抑制剂的使用与临床结局之间的关联。
我们使用韩国健康保险审查和评估数据库进行了一项全国性的基于人群的队列研究。对截至 2020 年 4 月 8 日接受 COVID-19 检测的 6979 名个体的理赔记录进行了筛查。使用调整后的优势比（OR）来比较 RAAS 抑制剂使用者与非使用者之间的临床结局。
在 5179 例确诊的 COVID-19 病例中，有 762 例患者为 RAAS 抑制剂使用者，4417 例患者为非使用者。与非使用者相比，RAAS 抑制剂使用者年龄更大、男性更多且合并症更多。在 1954 例 COVID-19 住院患者中，有 377 例患者为 RAAS 抑制剂使用者，1577 例患者为非使用者。RAAS 抑制剂使用者中有 33 例（9%）发生院内死亡，而非使用者中有 51 例（3%）（P<0.001）。然而，在校正年龄、性别、Charlson 合并症指数、免疫抑制和医院类型后，RAAS 抑制剂的使用与死亡率升高无关（调整后的 OR，0.88；95%置信区间，0.53-1.44；P=0.60）。在使用血管加压药、通气模式、体外膜氧合、肾脏替代治疗和急性心脏事件方面，RAAS 抑制剂使用者与非使用者之间没有显著差异。
我们的研究结果表明，在韩国 COVID-19 患者中，RAAS 抑制剂的使用与死亡率无关。
