Intensive Care Unit, Hôpital du Valais, Sion, Switzerland.
Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland.
Physiol Rep. 2022 Nov;10(22):e15512. doi: 10.14814/phy2.15512.
Previous studies suggested that ongoing treatment with renin-angiotensin-aldosterone system (RAAS) inhibitor drugs may alter the course of SARS-CoV-2 infection and promote the development of more severe forms of the disease. The authors conducted a comparative, observational study to retrospectively analyze data collected from 394 patients admitted to ICU due to SARS-CoV-2 pneumonia. The primary aim of the study was to establish an association between the use of RAAS inhibitor drugs and mortality in the ICU. The secondary aims of the study were to establish an association between the use of RAAS inhibitor drugs and clinical severity at ICU admission, the need for tracheal intubation, total days of mechanical ventilation, and the ICU length of stay. The authors found no statistically significant difference in ICU mortality between patients on RAAS inhibitor drugs at admission and those who were not (31.3% versus 26.2% mortality, p-value 0.3). However, the group of patients taking RAAS inhibitor drugs appeared to be more critical at ICU admission, and this difference became statistically significant in the subgroup of non-hypertensive patients. ICU mortality in the subgroup of non-hypertensive patients treated with RAAS inhibitor drugs also tended to be higher. Overexpression of the angiotensin-converting enzyme 2 (ACE2) in human cells, induced by RAAS inhibitor drugs, promotes viral entry-replication of SARS-CoV-2 and alters the basal balance of the RAAS, which may explain the findings observed in the present study. These phenomena may be amplified in non-hypertensive patients treated with RAAS inhibitor therapy.
先前的研究表明，持续使用肾素-血管紧张素-醛固酮系统（RAAS）抑制剂可能会改变 SARS-CoV-2 感染的进程，并促进疾病向更严重的形式发展。作者进行了一项比较性、观察性研究，回顾性分析了因 SARS-CoV-2 肺炎而入住 ICU 的 394 名患者的数据。该研究的主要目的是确定 RAAS 抑制剂药物的使用与 ICU 死亡率之间的关联。该研究的次要目的是确定 RAAS 抑制剂药物的使用与 ICU 入院时的临床严重程度、气管插管的需要、机械通气的总天数和 ICU 住院时间之间的关联。作者发现，入院时使用 RAAS 抑制剂药物的患者与未使用 RAAS 抑制剂药物的患者在 ICU 死亡率方面无统计学显著差异（31.3%与 26.2%的死亡率，p 值为 0.3）。然而，接受 RAAS 抑制剂药物治疗的患者在 ICU 入院时似乎更为危急，这种差异在非高血压患者亚组中具有统计学意义。在接受 RAAS 抑制剂药物治疗的非高血压患者亚组中，ICU 死亡率也有升高的趋势。RAAS 抑制剂药物诱导的人细胞中血管紧张素转换酶 2（ACE2）的过表达，促进了 SARS-CoV-2 的病毒进入-复制，并改变了 RAAS 的基础平衡，这可能解释了本研究中的观察结果。这些现象在接受 RAAS 抑制剂治疗的非高血压患者中可能会被放大。
