ElAbd Rawan, AlTarrah Dana, AlYouha Sarah, Bastaki Hamad, Almazeedi Sulaiman, Al-Haddad Mohannad, Jamal Mohammad, AlSabah Salman
Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
Faculty of Public Health, Kuwait University, Safat, Kuwait.
Front Med (Lausanne). 2021 Mar 4;8:600385. doi: 10.3389/fmed.2021.600385. eCollection 2021.
Corona Virus disease 2019 (COVID-19) caused by the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic. The aim of this study was to investigate the impact of being on an Angiotensin-Converting Enzyme Inhibitors (ACEI) and/or Angiotensin Receptor Blockers (ARB) on hospital admission, on the following COVID-19 outcomes: disease severity, ICU admission, and mortality. The charts of all patients consecutively diagnosed with COVID-19 from the 24th of February to the 16th of June of the year 2020 in Jaber Al-Ahmed Al-Sabah hospital in Kuwait were checked. All related patient information and clinical data was retrieved from the hospitals electronic medical record system. The primary outcome was COVID-19 disease severity defined as the need for Intensive Care Unit (ICU) admission. Secondary outcome was mortality. A total of 4,019 COVID-19 patients were included, of which 325 patients (8.1%) used ACEI/ARB, users of ACEI/ARB were found to be significantly older (54.4 vs. 40.5 years). ACEI/ARB users were found to have more co-morbidities; diabetes (45.8 vs. 14.8%) and hypertension (92.9 vs. 13.0%). ACEI/ARB use was found to be significantly associated with greater risk of ICU admission in the unadjusted analysis [OR, 1.51 (95% CI: 1.04-2.19), = 0.028]. After adjustment for age, gender, nationality, coronary artery disease, diabetes and hypertension, ICU admission was found to be inversely associated with ACEI use [OR, 0.57 (95% CI: 0.34-0.88), = 0.01] and inversely associated with mortality [OR, 0.56 (95% CI: 0.33-0.95), = 0.032]. The current evidence in the literature supports continuation of ACEI/ARB medications for patients with co-morbidities that acquire COVID-19 infection. Although, the protective effects of such medications on COVID-19 disease severity and mortality remain unclear, the findings of the present study support the use of ACEI/ARB medication.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）已成为全球大流行疾病。本研究的目的是调查使用血管紧张素转换酶抑制剂（ACEI）和/或血管紧张素受体阻滞剂（ARB）对住院的影响，以及对以下COVID-19结局的影响：疾病严重程度、入住重症监护病房（ICU）情况和死亡率。对科威特贾比尔·艾哈迈德·萨巴赫医院2020年2月24日至6月16日期间连续诊断为COVID-19的所有患者的病历进行了检查。所有相关患者信息和临床数据均从医院电子病历系统中获取。主要结局是COVID-19疾病严重程度，定义为需要入住重症监护病房（ICU）。次要结局是死亡率。共纳入4019例COVID-19患者，其中325例患者（8.1%）使用ACEI/ARB，发现使用ACEI/ARB的患者年龄显著更大（54.4岁对40.5岁）。发现使用ACEI/ARB的患者合并症更多；糖尿病（45.8%对14.8%）和高血压（92.9%对13.0%）。在未调整分析中，发现使用ACEI/ARB与入住ICU的风险显著增加相关[比值比（OR），1.51（95%置信区间：1.04 - 2.19），P = 0.028]。在对年龄、性别、国籍、冠状动脉疾病（冠心病）、糖尿病和高血压进行调整后，发现入住ICU与使用ACEI呈负相关[OR，0.57（95%置信区间：0.34 - 0.88），P = 0.01]，与死亡率也呈负相关[OR，0.56（95%置信区间：0.33 - 0.95），P = 0.032]。文献中的现有证据支持患有合并症且感染COVID-19的患者继续使用ACEI/ARB药物。尽管此类药物对COVID-19疾病严重程度和死亡率的保护作用仍不明确，但本研究结果支持使用ACEI/ARB药物。
