ABSTRACT
Background: The virus responsible for COVID-19 enters human cells by binding angiotensinconverting enzyme 2. The influence of renin-angiotensin-aldosterone system (RAAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), remains uncertain. Aim: To examine the role of ACEi / ARB exposure on outcomes in COVID-19 patients with preexisting hypertension (HTN) admitted to intensive care units (ICU). Methods: The COVID-19 Critical Care Consortium is a prospective, observational cohort study of patients requiring ICU admission for active COVID-19 spanning 354 participating sites in 54 countries. Patients >18 years old with pre-existing HTN requiring antihypertensive therapy were analysed. Length of stay and in-hospital mortality to 90 days post ICU admission were analysed as time-to-eventoutcomes by multistate survival analysis, and the influence of ACEi / ARB use on the hazards of death and discharge by multi-state Cox proportional hazard modelling and sensitivity analysis. Results: From December 1, 2019 through December 30, 2020, 663 eligible patients were registered. Of these, 480 patients had received ACEi and / or ARB therapy (median age 65 years, 67% male) in the 2 weeks before ICU admission, while 183 had not (66 years, 61% male). Average lengths of ICU and general ward stays were longer in the ACEi / ARB than non-ACEi / ARB group (20.8 days and 6.5 days vs. 15.5 and 6.0 days, respectively). ACEi / ARB use was associated with a decreased hazard of death (HR, 0.69, 95% CI, 0.54 -0.88) that persisted after adjusting for propensity scores (0.67, 0.53 -0.86). Cumulative probabilities (unadjusted for baseline characteristics) for death and discharge post ICU admission are depicted in the figure for ACEi/ARB (red) and non-ACEi / ARB (blue) patients. Conclusions: In 663 critically ill COVID-19 patients with pre-existing HTN, RAAS inhibition pre-ICU admission was linked to reduced in-hospital mortality.
ABSTRACT
Objective: SARS-CoV-2 has been reported in almost all countries around the world, and a significant proportion of critically ill patients with COVID-19 require care in the intensive care unit (ICU). There have been few observational cohorts including patients in ICU across different countries. We present summary data from a global critical care consortium. Methods: The COVID-19 Critical Care Consortium/ ECMOCARD (COVID-19 CCC/ECMOCARD) is an ongoing international multicenter observational study including more than 377 hospitals in 53 countries. Clinical and treatment characteristics are collected for patients with COVID-19 requiring ICU admission. Results: Data from 2,670 patients with COVID-19 admitted between January 28 and December 19, 2020 were summarized - 182 from Africa, 516 from Asia, 72 from Oceania, 710 from Europe, 343 from Latin America, and 847 from North America. The median (IQR) age was 59 (49 to 68) years, and 909 (34%) were female. 1,283 (49%) patients had hypertension and 830 (32%) had diabetes mellitus. The time from symptom onset to hospital admission was 7 (3 to 10) days, and 1,360 (51%) patients were admitted to ICU on the same day as hospital admission. Upon ICU admission, the heart rate was 95 (80 to 110) beats/min, respiratory rate was 26 (20 to 33) breaths/ min, and oxygen saturation was 93 (89 to 96) %. Details of arterial blood gases and ICU interventions are tabulated. Amongst survivors, ICU length of stay (LOS) was 13 (7 to 25) days, and hospital LOS was 24 (14 to 39) days. As of 31 December 2020, 1,358 (51%) patients were discharged from ICU, and 1,219 (46%) patients survived to hospital discharge. Among 963 (36%) patients who died in hospital, 837 (87%) died within 28 days of ICU admission. Conclusions: The COVID-19 CCC/ECMO offers a unique global perspective of characteristics and outcomes of patients with COVID-19 requiring admission to the ICU.