Vascul Pharmacol. 2020 Dec;135:106805. doi: 10.1016/j.vph.2020.106805. Epub 2020 Sep 28.
The hypothesis that been set forward that use of Renin Angiotensin Aldosterone System (RAAS) inhibitors is associated with COVID-19 severity. We set-up a multicenter Italian collaboration (CORIST Project, ClinicalTrials.gov ID: NCT04318418) to retrospectively investigate the relationship between RAAS inhibitors and COVID-19 in-hospital mortality. We also carried out an updated meta-analysis on the relevant studies.
We analyzed 4069 unselected patients with laboratory-confirmed SARS-CoV-2 infection and hospitalized in 34 clinical centers in Italy from February 19, 2020 to May 23, 2020. The primary end-point in a time-to event analysis was in-hospital death, comparing patients who received angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB) with patients who did not. Articles for the meta-analysis were retrieved until July 13th, 2020 by searching in web-based libraries, and data were combined using the general variance-based method.
Out of 4069 COVID-19 patients, 13.5% and 13.3% received ACE-I or ARB, respectively. Use of neither ACE-I nor ARB was associated with mortality (multivariable hazard ratio (HR) adjusted also for COVID-19 treatments: 0.96, 95% confidence interval 0.77-1.20 and HR = 0.89, 0.67-1.19 for ACE-I and ARB, respectively). Findings were similar restricting the analysis to hypertensive (N = 2057) patients (HR = 1.00, 0.78-1.26 and HR = 0.88, 0.65-1.20) or when ACE-I or ARB were considered as a single group. Results from the meta-analysis (19 studies, 29,057 COVID-19 adult patients, 9700 with hypertension) confirmed the absence of association.
In this observational study and meta-analysis of the literature, ACE-I or ARB use was not associated with severity or in-hospital mortality in COVID-19 patients.
提出了这样一个假说，即使用肾素-血管紧张素-醛固酮系统（RAAS）抑制剂与 COVID-19 的严重程度有关。我们建立了一个多中心的意大利合作项目（CORIST 项目，ClinicalTrials.gov ID：NCT04318418），以回顾性调查 RAAS 抑制剂与 COVID-19 住院死亡率之间的关系。我们还对相关研究进行了更新的荟萃分析。
我们分析了 2020 年 2 月 19 日至 2020 年 5 月 23 日在意大利 34 个临床中心住院的 4069 例经实验室确诊的 SARS-CoV-2 感染的未选择患者。在时间事件分析中，主要终点是住院死亡，比较接受血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）的患者与未接受 ACEI 或 ARB 的患者。通过在网络库中搜索，直到 2020 年 7 月 13 日检索到荟萃分析的文章，并使用基于一般方差的方法合并数据。
在 4069 例 COVID-19 患者中，分别有 13.5%和 13.3%接受 ACE-I 或 ARB。既不使用 ACE-I 也不使用 ARB 与死亡率相关（多变量调整后的 COVID-19 治疗后的危险比（HR）：0.96，95%置信区间 0.77-1.20；HR=0.89，0.67-1.19，ACE-I 和 ARB 分别）。在限制分析为高血压（N=2057）患者（HR=1.00，0.78-1.26；HR=0.88，0.65-1.20）或 ACE-I 或 ARB 被视为单一组时，结果相似。荟萃分析的结果（19 项研究，29057 例 COVID-19 成年患者，9700 例高血压患者）证实了这种无关联。
在这项观察性研究和文献荟萃分析中，ACE-I 或 ARB 的使用与 COVID-19 患者的严重程度或住院死亡率无关。
