Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia.
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
BMC Cardiovasc Disord. 2022 Mar 23;22(1):123. doi: 10.1186/s12872-022-02565-1.
The influence of renin-angiotensin-aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients.
Data from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included. A cohort of 737 COVID-19 patients with pre-existing hypertension admitted to intensive care units (ICUs) in 2020 were targeted. Multi-state survival analysis was performed to evaluate in-hospital mortality and hospital length of stay up to 90 days following ICU admission.
A total of 737 patients were included-538 (73%) with pre-existing hypertension had received ACEi/ARBs before ICU admission, while 199 (27%) had not. Cox proportional hazards model showed that previous ACEi/ARB use was associated with a decreased hazard of in-hospital death (HR, 0.74, 95% CI 0.58-0.94). Sensitivity analysis adjusted for propensity scores showed similar results for hazards of death. The average length of hospital stay was longer in ACEi/ARB group with 21.2 days (95% CI 19.7-22.8 days) in ICU and 6.7 days (5.9-7.6 days) in general ward compared to non-ACEi/ARB group with 16.2 days (14.1-18.6 days) and 6.4 days (5.1-7.9 days), respectively. When analysed separately, results for ACEi or ARB patient groups were similar for both death and discharge.
In critically ill COVID-19 patients with comorbid hypertension, use of ACEi/ARBs prior to ICU admission was associated with a reduced risk of in-hospital mortality following adjustment for baseline characteristics although patients with ACEi/ARB showed longer length of hospital stay. Clinical trial registration The registration number: ACTRN12620000421932; The date of registration: 30, March 2020; The URL of the registration: https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12620000421932 .
肾素-血管紧张素-醛固酮系统（RAAS）抑制剂对患有合并高血压的危重症 COVID-19 患者的影响仍不确定。本研究旨在探讨血管紧张素转换酶抑制剂（ACEi）和血管紧张素受体阻滞剂（ARB）的既往使用对危重症 COVID-19 患者的影响。
本研究纳入了一项国际性、前瞻性、观察性队列研究的数据，该研究涉及 54 个国家的 354 家医院。该队列纳入了 2020 年入住 ICU 的 737 例患有合并高血压的 COVID-19 患者。采用多状态生存分析评估 ICU 入院后 90 天内的院内死亡率和住院时间。
共纳入 737 例患者，其中 538 例（73%）在 ICU 入院前接受了 ACEi/ARB 治疗，199 例（27%）未接受。Cox 比例风险模型显示，既往 ACEi/ARB 治疗与院内死亡风险降低相关（HR 0.74，95%CI 0.58-0.94）。调整倾向评分后的敏感性分析结果也显示死亡风险相似。ACEi/ARB 组 ICU 住院时间为 21.2 天（95%CI 19.7-22.8 天），普通病房住院时间为 6.7 天（5.9-7.6 天），而非 ACEi/ARB 组 ICU 住院时间为 16.2 天（14.1-18.6 天），普通病房住院时间为 6.4 天（5.1-7.9 天）。分别分析 ACEi 或 ARB 患者组的结果显示，在死亡和出院方面均类似。
在患有合并高血压的危重症 COVID-19 患者中，尽管 ACEi/ARB 组的住院时间较长，但 ICU 入院前使用 ACEi/ARB 与院内死亡率降低相关，调整基线特征后结果相似。
ACTRN12620000421932；注册日期：2020 年 3 月 30 日；注册网址：https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12620000421932。
