San Franciso Veterans Affairs Medical Center, San Francisco, CA, USA
Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA.
BMJ Open. 2021 Dec 31;11(12):e050051. doi: 10.1136/bmjopen-2021-050051.
SARS-CoV-2 enters cells using the ACE2 receptor. Medications that affect ACE2 expression or function such as angiotensin receptor blockers (ARBs) and ACE inhibitors (ACE-I) and metformin have the potential to counter the dysregulation of ACE2 by the virus and protect against viral injury. Here, we describe COVID-19 survival associated with ACE-I, ARB and metformin use.
This is a hospital-based observational study of patients with COVID-19 infection using logistic regression with correction for pre-existing conditions and propensity score weighted Cox proportional hazards models to estimate associations between medication use and mortality.
Medical record data from the US Veterans Affairs (VA) were used to identify patients with a reverse transcription PCR diagnosis of COVID-19 infection, to classify patterns of ACE inhibitors (ACE-I), ARB, beta blockers, metformin, famotidine and remdesivir use, and, to capture mortality.
9532 hospitalised patients with COVID-19 infection followed for 60 days were analysed.
Death from any cause within 60 days of COVID-19 diagnosis was examined.
Discontinuation of ACE-I was associated with increased risk of death (OR: 1.4; 95% CI 1.2-1.7). Initiating (OR: 0.3; 95% CI 0.2-0.5) or continuous (OR: 0.6; 95% CI 0.5-0.7) ACE-I was associated with reduced risk of death. ARB and metformin associations were similar in direction and magnitude and also statistically significant. Results were unchanged when accounting for pre-existing morbidity and propensity score adjustment.
Recent randomised clinical trials support the safety of continuing ACE-I and ARB treatment in patients with COVID-19 where indicated. Our study extends these findings to suggest a possible COVID-19 survival benefit for continuing or initiating ACE-I, ARB and metformin medications. Randomised trials are appropriate to confirm or refute the therapeutic potential for ACE-I, ARBs and metformin.
SARS-CoV-2 通过 ACE2 受体进入细胞。影响 ACE2 表达或功能的药物，如血管紧张素受体阻滞剂 (ARB) 和血管紧张素转换酶抑制剂 (ACE-I) 和二甲双胍，有可能对抗病毒对 ACE2 的失调并防止病毒损伤。在这里，我们描述了与 ACE-I、ARB 和二甲双胍使用相关的 COVID-19 存活情况。
这是一项基于医院的观察性研究，使用逻辑回归对预先存在的疾病和倾向评分加权 Cox 比例风险模型进行校正，以估计药物使用与死亡率之间的关联，该研究使用美国退伍军人事务部 (VA) 的病历数据来识别经逆转录 PCR 诊断为 COVID-19 感染的患者，对 ACE 抑制剂 (ACE-I)、ARB、β受体阻滞剂、二甲双胍、法莫替丁和瑞德西韦的使用模式进行分类，并捕捉死亡率。
对 9532 名住院 COVID-19 感染患者进行了 60 天的随访分析。
COVID-19 诊断后 60 天内任何原因导致的死亡。
停止使用 ACE-I 与死亡风险增加相关（OR：1.4；95%CI 1.2-1.7）。开始（OR：0.3；95%CI 0.2-0.5）或持续（OR：0.6；95%CI 0.5-0.7）使用 ACE-I 与降低死亡风险相关。ARB 和二甲双胍的相关性在方向和程度上相似，且具有统计学意义。在考虑预先存在的发病率和倾向评分调整后，结果仍然不变。
最近的随机临床试验支持在有指征的情况下继续使用 ACE-I 和 ARB 治疗 COVID-19 患者的安全性。我们的研究将这些发现扩展到表明继续或开始使用 ACE-I、ARB 和二甲双胍药物可能对 COVID-19 存活有益。随机试验适合确认或反驳 ACE-I、ARB 和二甲双胍的治疗潜力。
