Braude Philip, Carter Ben, Short Roxanna, Vilches-Moraga Arturo, Verduri Alessia, Pearce Lyndsay, Price Angeline, Quinn Terence J, Stechman Michael, Collins Jemima, Bruce Eilidh, Einarsson Alice, Rickard Frances, Mitchell Emma, Holloway Mark, Hesford James, Barlow-Pay Fenella, Clini Enrico, Myint Phyo Kyaw, Moug Susan, McCarthy Kathryn, Hewitt Jonathan
Department for Medicine for Older People, North Bristol NHS Trust, Bristol, UK.
Department of Biostatistics and Health Informatics, King's College London, UK.
Int J Cardiol Heart Vasc. 2020 Dec;31:100660. doi: 10.1016/j.ijcha.2020.100660. Epub 2020 Oct 15.
During the COVID-19 pandemic the continuation or cessation of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) has been contentious. Mechanisms have been proposed for both beneficial and detrimental effects. Recent studies have focused on mortality with no literature having examined length of hospital stay. The aim of this study was to determine the influence of ACEi and ARBs on COVID-19 mortality and length of hospital stay.
COPE (COVID-19 in Older People) is a multicenter observational study including adults of all ages admitted with either laboratory or clinically confirmed COVID-19. Routinely generated hospital data were collected. Primary outcome: mortality; secondary outcomes: Day-7 mortality and length of hospital stay. A mixed-effects multivariable Cox's proportional baseline hazards model and logistic equivalent were used.
1371 patients were included from eleven centres between 27th February to 25th April 2020. Median age was 74 years [IQR 61-83]. 28.6% of patients were taking an ACEi or ARB. There was no effect of ACEi or ARB on inpatient mortality (aHR = 0.85, 95%CI 0.65-1.11). For those prescribed an ACEi or ARB, hospital stay was significantly reduced (aHR = 1.25, 95%CI 1.02-1.54, p = 0.03) and in those with hypertension the effect was stronger (aHR = 1.39, 95%CI 1.09-1.77, p = 0.007).
Patients and clinicians can be reassured that prescription of an ACEi or ARB at the time of COVID-19 diagnosis is not harmful. The benefit of prescription of an ACEi or ARB in reducing hospital stay is a new finding.
在新型冠状病毒肺炎（COVID-19）大流行期间，血管紧张素转换酶抑制剂（ACEi）和血管紧张素受体阻滞剂（ARBs）的继续使用或停用一直存在争议。已经提出了其有益和有害影响的机制。近期研究聚焦于死亡率，尚无文献研究住院时间。本研究的目的是确定ACEi和ARBs对COVID-19死亡率和住院时间的影响。
COPE（老年人中的COVID-19）是一项多中心观察性研究，纳入所有年龄因实验室确诊或临床确诊COVID-19而入院的成年人。收集常规生成的医院数据。主要结局：死亡率；次要结局：第7天死亡率和住院时间。使用混合效应多变量Cox比例基线风险模型和逻辑等效模型。
2020年2月27日至4月25日期间，来自11个中心的1371例患者被纳入研究。中位年龄为74岁[四分位间距61 - 83岁]。28.6%的患者正在服用ACEi或ARB。ACEi或ARB对住院患者死亡率无影响（调整后风险比[aHR]=0.85，95%置信区间[CI]0.65 - 1.11）。对于那些开具了ACEi或ARB的患者，住院时间显著缩短（aHR = 1.25，95%CI 1.02 - 1.54，p = 0.03），在高血压患者中这种效果更强（aHR = 1.39，95%CI 1.09 - 1.77，p = 0.007）。
患者和临床医生可以放心，在COVID-19诊断时开具ACEi或ARB并无危害。ACEi或ARB处方在缩短住院时间方面的益处是一项新发现。
