Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Broca, Service de gériatrie, F-75013, Paris, France.
Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Broca, Service de gériatrie, F-75013, Paris, France; EA 4468, Université de Paris, F-75013, Paris, France.
J Am Med Dir Assoc. 2020 Nov;21(11):1539-1545. doi: 10.1016/j.jamda.2020.09.004. Epub 2020 Sep 9.
The role of treatment with renin-angiotensin-aldosterone system blockers at the onset of COVID-19 infection is not known in the geriatric population. The aim of this study was to assess the relationship between angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitor (ACEI) use and in-hospital mortality in geriatric patients hospitalized for COVID-19.
This observational retrospective study was conducted in a French geriatric department. Patients were included between March 17 and April 18, 2020.
All consecutive 201 patients hospitalized for COVID-19 (confirmed by reverse-transcriptase polymerase chain reaction methods) were included. All nondeceased patients had 30 days of follow-up and no patient was lost to follow-up.
Demographic, clinical, and biological data and medications were collected. In-hospital mortality of patients treated or not by ACEI/ARB was analyzed using multivariate Cox models.
Mean age of the population was 86.3 (8.0) years, 62.7% of patients were institutionalized, 88.6% had dementia, and 53.5% had severe disability (activities of daily living [ADL] score <2). Sixty-three patients were treated with ACEI/ARB and 138 were not. Mean follow-up was 23.4 (10.0) days, 66 (33.8%) patients died after an average of 10.0 days (6.0). Lower mortality rate was observed in patients treated with ACEI/ARB compared with patients not treated with ARB or ACEI (22.2% [14] vs 37.7% [52], hazard ratio [HR] 0.54; 95% confidence interval 0.30-0.97; P = .03). In a multivariate Cox regression model including age, sex, ADL score, Charlson index, renal function, dyspnea, C-reactive protein, and white blood cell count, use of ACEI/ARB was significantly associated with lower in-hospital mortality (HR 0.52 (0.27-0.99), P = .048).
In very old subjects hospitalized in geriatric settings for COVID-19, mortality was significantly lower in subjects treated with ARB or ACEI before the onset of infection. The continuation of ACEI/ARB therapy should be encouraged during periods of coronavirus outbreak in older subjects.
在老年人群中，尚不清楚肾素-血管紧张素-醛固酮系统阻滞剂在 COVID-19 感染发作时的作用。本研究旨在评估血管紧张素受体阻滞剂（ARB）和血管紧张素转换酶抑制剂（ACEI）在因 COVID-19 住院的老年患者中的使用与院内死亡率之间的关系。
这是一项在法国老年科进行的观察性回顾性研究。患者于 2020 年 3 月 17 日至 4 月 18 日期间入选。
共纳入 201 例因 COVID-19（通过逆转录酶聚合酶链反应方法确诊）住院的连续患者。所有非死亡患者均随访 30 天，无患者失访。
收集人口统计学、临床和生物学数据以及药物使用情况。使用多变量 Cox 模型分析接受 ACEI/ARB 治疗或未接受 ACEI/ARB 治疗的患者的院内死亡率。
人群平均年龄为 86.3（8.0）岁，62.7%的患者为机构化，88.6%有痴呆，53.5%有严重残疾（日常生活活动评分[ADL] <2）。63 例患者接受 ACEI/ARB 治疗，138 例未接受 ACEI/ARB 治疗。平均随访 23.4（10.0）天，平均 10.0 天后（6.0 天）有 66 例（33.8%）患者死亡。与未接受 ARB 或 ACEI 治疗的患者相比，接受 ACEI/ARB 治疗的患者死亡率较低（22.2%[14] vs 37.7%[52]，风险比[HR]0.54；95%置信区间 0.30-0.97；P=0.03）。在包括年龄、性别、ADL 评分、Charlson 指数、肾功能、呼吸困难、C 反应蛋白和白细胞计数在内的多变量 Cox 回归模型中，ACEI/ARB 的使用与较低的院内死亡率显著相关（HR 0.52（0.27-0.99），P=0.048）。
在因 COVID-19 住院的老年患者中，在感染发作前接受 ARB 或 ACEI 治疗的患者死亡率显著降低。在老年患者冠状病毒爆发期间，应鼓励继续使用 ACEI/ARB 治疗。
