Kheyri Zahedin, Alizadeh Mahboobeh, Akbarpour Samaneh, Hosamirudsari Hadiseh, Niya Mohammad H K, Aliasgharpour Fatemeh, Meidan Mohadeseh M, Hassanzadeh Shahrbanoo, Dowran Razieh, Jafarpour Ali
Department of Internal Medicine, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Infectious Disease Department, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Adv Biomed Res. 2022 Dec 26;11:109. doi: 10.4103/abr.abr_177_21. eCollection 2022.
Safe use of drugs such as angiotensin-converting enzyme 2 (ACE2) inhibitors and angiotensin receptor blockers (ARBs) in COVID diabetic patients needs comprehensive studies. This study addressed this issue from the Iranian perspective.
Admitted COVID-19 patients were divided into four groups in this historical cohort study. Group 1 included 740 non-diabetic, non-hypertensive patients. Group 2 included 132 non-hypertensive diabetic patients. Group 3 included 154 non-diabetic hypertensive patients. Group 4 included 183 diabetic patients who were under ACE inhibitors or ARBs. Death, intensive care unit (ICU) admission, and length of hospitalization were compared between the groups.
After considering associated factors such as age, gender, dyslipidemia, cardiovascular diseases, rheumatoid arthritis (RA), chronic kidney disease (CKD), history of surgery, and corticosteroid use, diabetic patients (group 2) were associated with increased mortality (CI 95%, OR 1.93 [1.11-3.33]). Presence of diabetes (group 2) and hypertension were associated with an increased need for ICU admission (CI 95%, OR 1.69 [1.04-2.76]; CI 95%, OR 1.71 [1.08-2.71], respectively). Group 4 patients although having a similar rate of ICU admission with group 2 and 3 patients, had significantly better ICU survival.
The current study suggests that ACE inhibitors and ARBs are associated with decreased mortality, ICU admission, and better ICU survival in the diabetic subgroup of hypertensive patients.
在新冠糖尿病患者中安全使用血管紧张素转换酶2（ACE2）抑制剂和血管紧张素受体阻滞剂（ARB）等药物需要进行全面研究。本研究从伊朗的角度探讨了这一问题。
在这项历史性队列研究中，将收治的新冠患者分为四组。第一组包括740名非糖尿病、非高血压患者。第二组包括132名非高血压糖尿病患者。第三组包括154名非糖尿病高血压患者。第四组包括183名正在使用ACE抑制剂或ARB的糖尿病患者。比较各组之间的死亡、重症监护病房（ICU）入院情况和住院时间。
在考虑年龄、性别、血脂异常、心血管疾病、类风湿关节炎（RA）、慢性肾脏病（CKD）、手术史和皮质类固醇使用等相关因素后，糖尿病患者（第二组）的死亡率增加（95%置信区间，比值比1.93[1.11 - 3.33]）。糖尿病（第二组）和高血压与ICU入院需求增加相关（分别为95%置信区间，比值比1.69[1.04 - 2.76]；95%置信区间，比值比1.71[1.08 - 2.71]）。第四组患者尽管与第二组和第三组患者的ICU入院率相似，但ICU生存率明显更高。
本研究表明，ACE抑制剂和ARB与高血压患者糖尿病亚组的死亡率降低、ICU入院率降低及更好的ICU生存率相关。
