Nunes José Pedro L
Faculdade de Medicina, Universidade do Porto.
Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal.
Porto Biomed J. 2020 Nov 11;5(6):e085. doi: 10.1097/j.pbj.0000000000000085. eCollection 2020 Nov-Dec.
Interest exists concerning the use of angiotensin-converting enzyme inhibitors (ACEis) in patients with COVID-19 disease.
The aim of the study was to perform a systematic review on mortality associated to the use of ACEi in patients with COVID-19 disease.
Search in Medline (PubMed), in ISI Web of Knowledge and in medRxiv database; use of other sources.
A total of 33 articles were evaluated. Concerning the papers used to produce the meta-analyses, 7 studies were selected, 5 of which were used. These 5 studies involved a total number of 944 patients treated with ACEi and 5173 not treated with ACEi. Increased mortality was seen in association to the use of ACEi in the context of COVID-19 disease (ACEi users vs nonusers; odds ratio, 1.48; 95% confidence interval, 1.02-2.15; = .04). When compared to mortality in patients treated with angiotensin receptor blockers, mortality of patients treated with ACEi was not significantly different (odds ratio, 0.96; 95% confidence interval, 0.76-1.21; = .74). Concerning the remaining reports, different types of data adjustments were used by several authors, after which increased mortality was not seen in association to the use of ACEi in this context.
ACEi use could act as a marker of increased mortality risk in some but not all COVID-19 disease settings. The data now presented do not prove a causal relation but argue in favor of carrying out clinical trials studying ACEi in COVID-19 patients, to establish the safety of ACEi use in this context.
对于在新型冠状病毒肺炎（COVID-19）患者中使用血管紧张素转换酶抑制剂（ACEi）存在关注。
本研究的目的是对COVID-19患者使用ACEi相关的死亡率进行系统评价。
检索Medline（PubMed）、ISI Web of Knowledge和medRxiv数据库；使用其他来源。
共评估了33篇文章。关于用于进行荟萃分析的论文，选择了7项研究，其中5项被采用。这5项研究共纳入944例接受ACEi治疗的患者和5173例未接受ACEi治疗的患者。在COVID-19疾病背景下，使用ACEi与死亡率增加相关（ACEi使用者与非使用者相比；优势比，1.48；95%置信区间，1.02 - 2.15；P = 0.04）。与接受血管紧张素受体阻滞剂治疗的患者死亡率相比，接受ACEi治疗的患者死亡率无显著差异（优势比，0.96；95%置信区间，0.76 - 1.21；P = 0.74）。关于其余报告，几位作者使用了不同类型的数据调整，之后在此背景下未发现使用ACEi与死亡率增加相关。
在部分但并非所有COVID-19疾病情况下，使用ACEi可能是死亡率风险增加的一个标志。目前呈现的数据并未证明因果关系，但支持开展针对COVID-19患者使用ACEi的临床试验，以确定在此背景下使用ACEi的安全性。
