| Title: |
Impact of renin–angiotensin–aldosterone system inhibition on mortality in critically ill COVID-19 patients with pre-existing hypertension: a prospective cohort study |
| Authors: |
Sato K.; White N.; Fanning J. P.; Obonyo N.; Yamashita M. H.; Appadurai V.; Ciullo A.; May M.; Worku E. T.; Helms L.; Ohshimo S.; Juzar D. A.; Suen J. Y.; Bassi G. L.; Fraser J. F.; Arora R. C.; Dalton H. J.; Laffey J.; Brodie D.; Fan E.; Torres A.; Chiumello D.; Elhazmi A.; Hodgson C.; Ichiba S.; Luna C.; Murthy S.; Nichol A.; Ng P. Y.; Ogino M.; Marwali E.; Yang I.; Dip G.; Grasselli G.; Bartlett R.; Burrell A. |
| Contributors: |
K. Sato; N. White; J.P. Fanning; N. Obonyo; M.H. Yamashita; V. Appadurai; A. Ciullo; M. May; E.T. Worku; L. Helm; S. Ohshimo; D.A. Juzar; J.Y. Suen; G.L. Bassi; J.F. Fraser; R.C. Arora; H.J. Dalton; J. Laffey; D. Brodie; E. Fan; A. Torre; D. Chiumello; A. Elhazmi; C. Hodgson; S. Ichiba; C. Luna; S. Murthy; A. Nichol; P.Y. Ng; M. Ogino; E. Marwali; I. Yang; G. Dip; G. Grasselli; R. Bartlett; A. Burrell |
| Publisher Information: |
BioMed Central |
| Publication Year: |
2022 |
| Collection: |
The University of Milan: Archivio Istituzionale della Ricerca (AIR) |
| Subject Terms: |
Angiotensin receptor blocker; Angiotensin-converting enzyme inhibitor; COVID-19; Critical care; Severe acute respiratory syndrome coronavirus 2; Settore MED/41 - Anestesiologia |
| Description: |
Background: 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. Methods: 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 90days following ICU admission. Results: 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 21.2days (95% CI 19.7–22.8days) in ICU and 6.7days (5.9–7.6days) in general ward compared to non-ACEi/ARB group with 16.2days (14.1–18.6days) and 6.4days (5.1–7.9days), respectively. When analysed separately, results for ACEi or ARB patient groups were similar for both death and discharge. Conclusions: 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: ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/35321649; info:eu-repo/semantics/altIdentifier/wos/WOS:000772425800002; volume:22; issue:1; firstpage:1; lastpage:12; numberofpages:12; journal:BMC CARDIOVASCULAR DISORDERS; https://hdl.handle.net/2434/970980 |
| DOI: |
10.1186/s12872-022-02565-1 |
| Availability: |
https://hdl.handle.net/2434/970980; https://doi.org/10.1186/s12872-022-02565-1 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.47959923 |
| Database: |
BASE |