ABSTRACT
Background: The first reports on coronaviruse disease 2019 (COVID-19) revealed an exaggerated mortality rate in hypertensive patients. In this regard, concerns about angiotensin-converting enzyme (ACE) inhibitors’ and angiotensin-receptor blockers’ (ARBs) have been aroused. Our aim in this study was to evaluate the potential bad outcome effect of hypertension and anti-hypertensive therapy on COVID-19. Methods: 183 patients with polymerase-chain-reaction (PCR)-proven COVID-19, who were admitted to our hospital and consulted to cardiology department between 15th of March and 15th of April 2020 were included. Data were recruited from hospital records. Results: Thirty-two out of 183 patients with COVID-19 died in hospital. Hypertension incidence was not statistically different between patients who survived and died (76 [50.3%] vs 19 [59.4%, p = 0.352]). Although the usage rate of ACEI were similar among groups, ARB usage rate was significantly higher in patients who died than survived (11 [34.4%] vs 23 [15.2%], p = 0.011). Binary regression analysis showed an association between ARBs and mortality (OR: 0.032, 95% CI 1.045–2.623, p = 0.032). Conclusion: Our study confirmed previous concerns regarding a potential harmful effects of ARBs on COVID-19 related mortality.
ABSTRACT
Aim: Although there are few studies on the predictive value of C-reactive protein-to-albumin ratio (CAR) in coronavirus disease-2019 (COVID-19) patients, to the best of our knowledge, there are no studies specifically conducted in COVID-19 patients with cardiovascular disease (CVD). This study assessed the use of baseline CAR levels to predict death in hospitalized COVID-19 patients with CVD. Methods: This study was designed as a single-center cross-sectional study. Patients diagnosed with COVID-19 who were admitted to the University of Health Sciences Turkey, Bagcilar Training and Research Hospital between April 16 and May 20, 2020 were analyzed retrospectively. The patients were divided into 2 groups: those who died and those who survived, considering the follow-up period. The CAR values of the study population, as well as patients with CVD, were calculated, and the association of CAR with in-hospital mortality was evaluated. Results: The in-hospital mortality rate was 11.1% (49/442 pts) in all populations. Deceased patients had significantly more frequent CVD (p<0.001) and the mortality rate was 34.4% (30/96 pts) in those patients. Median CAR values were higher in nonsurvivors than among survivors (p<0.001). Multivariate analysis demonstrated that CAR was an independent predictor of mortality in patients with CVD [hazard ratio 1.013 (95% confidence interval: 1.002-1.022), p=0.018]. Conclusion: CAR is an inflammatory risk marker that independently predicts mortality in all COVID-19 hospitalized patients and patients with CVD.
ABSTRACT
Background: Presepsin provides information about prognosis of various inflammatory diseases and helps guide therapy. The present study was aimed to evaluate presepsin levels in COVID-19 patients and assess its predictive value on severity and mortality of the disease. Materials and Methods: A total of 259 patients were divided into two groups according to severity of the disease. Patients with mild-moderate illness constituted group 0 and those with severe-critical illness constituted group 1. Biochemical parameters including hemogram, coagulation tests, C-reactive protein (CRP), procalcitonin, creatine kinase, troponin, D-dimer, presepsin, and liver and kidney function tests were assessed for each patient. Results: Group 1 patients were older and had a higher length of hospital stay and mortality compared to group 0 patients. Blood levels of urea, creatinine, lactate dehydrogenase (LDH), aspartate aminotransferase, ferritin, procalcitonin, CRP, activated partial thromboplastin time, troponin, and presepsin were statistically significantly higher and lymphocyte and albumin levels were significantly lower in group 1 patients than that of group 0 patients. Presepsin had a weak positive correlation with LDH (r = 0.147, P = 0.018) and troponin levels (r = 0.141, P = 0.024), and had a weak negative correlation with albumin level (r = -0.134, 0.031). According to multivariate logistic regression analysis, only lymphocyte count was an independent predictor of hospital mortality. Presepsin with a cutoff value of 42.79 pg/ml predicted severe-critical infection with 64.4% sensitivity and 52.5% specificity. It had a lower diagnostic value for prediction of disease severity compared to procalcitonin and CRP. Conclusion: Presepsin might be used in risk stratification of COVID-19 disease. Further studies are needed to delineate its prognostic value for survival.