ABSTRACT
Background and importance Identification of the angiotensin converting enzyme (ACE2) as a target of the SARS-CoV-2 virus raises questions about a possible change in the clinical course of this infection associated with inhibitors of the renin-angiotensin-aldosterone system (RAAS). Furthermore, high blood pressure is considered a risk factor for COVID-19. Aim and objectives To characterise the clinical course in hypertensive patients admitted for COVID-19 and to determine if treatment with RAAS inhibitors, age and additional comorbidities may be related to mortality and development of acute respiratory distress syndrome (ARDS). Material and methods A single centre, observational, retrospective study was conducted. Inclusion criteria were: diagnosis of hypertension, hospital admission for COVID-19 between 1 March and 24 March 2020. Demographic, clinical and analytical variables were recorded. Clinical course was evaluated by: development of bilateral pneumonia, ARDS, length of stay and mortality. End of follow-up was 10 October 2020. To evaluate the possible influence of factors on evolution, binary logistic regression was performed using the STATA-IC14 programme. Quantitative dependent variables were transformed into dichotomous variables. Statistical significance was defined as p<0.05. Results 571 patients were analysed, with a median age of 76 years (IQR 66-83) and 59.2% were men. Of these, 69.7% were receiving treatment with RAAS inhibitors, 7.2% smoked and 80.0% had additional comorbidities. At hospital admission, 27.3% presented with hypoxaemia (SatO2<90%), 64.3% lymphopenia (<1000/mm3), 18.8% C reactive protein >20 mg/dL and 11.7% D-dimer >1200 ng/mL. During the hospital stay, 91.9% of patients required oxygen therapy, 76.4% developed bilateral pneumonia, 91.9% required oxygen therapy, 47.5% developed ARDS and 33.6% died. Median hospital stay was 15 days (IQR 9-24). Use of RAAS inhibitors was not linked to changes in mortality or development of ARDS (p>0.05). Risk factors associated with mortality were: additional cardiovascular diseases (OR=2.10;p=0.000) and older age (OR=1.05;p=0.000). Regarding ARDS, we found an association with obesity (OR=1.77;p=0.013), diabetes mellitus (OR=1.84;p=0.001) and age (OR=1.02;p=0.010). Hospital stay >14 days was significantly longer in advanced age (OR=1.02;p=0.022) and if chronic kidney disease was present (OR=1.73, p=0.043). Conclusion and relevance Antihypertensive treatment with RAAS inhibitors did not seem to be linked to the risk of worse evolution of COVID-19. Advanced age and additional cardiovascular disease appeared to be associated with higher mortality in hypertensive patients.
ABSTRACT
Background and importance Cancer patients are a vulnerable population for SAR-CoV-2 infection. Aim and objectives The aim of our study was to describe the epidemiology and clinical course of patients with cancer infected with SARS-Cov-2, attending hospital. Material and methods A retrospective observational study was conducted in cancer patients attending a tertiary hospital for SARS-CoV-2 infection during the period 3 January 2020 to 31 May 2020. Demographic and clinical variables were analysed: comorbidities, tumour diagnosis, tumour stage and whether they had received anticancer treatment in the last month (active treatment). The clinical course was evaluated by hospital admission, pneumonia, oxygen therapy requirements, the development of acute respiratory distress syndrome (ARDS), admission to ICU, mortality rate and mortality rate <30 days from admission. Quantitative variables were expressed as means (SD). The association between dichotomous variables or proportions was compared using Fisher's exact test and between quantitative variables using the Mann-Whitney U test. Results 112 patients were included, 59.8% (67) were men, mean age 67±13.4 years. 94.6% (106) were Caucasian (4.4% (5) Latino). 61.6% (69) were non-smokers, 25% (28) exsmokers and 13.4% (15) current smokers;11.6% (13) had obesity. The most frequent comorbidities were: 57.1% (64) arterial hypertension, 34.8% (38) cardiovascular disease, 32.1% (36) diabetes mellitus and 21.4% (24) COPD. The most frequent cancer diagnosis were: 18.8% (21) breast cancer, 17.9% (20) lung cancer, 16.1% (18) colorectal cancer and 12.5% (14) prostate cancer. Tumour stage: 55.4% (62) metastatic disease, 25% (28) localised disease and 19.6% (22) locally advanced disease. 60.7% (68) of patients received active cancer treatment (42.7% chemotherapy, 32.3% hormonal treatment, 16.2% targeted therapy, 7% immunotherapy and 2.9% radiotherapy). At admission, 85.7% (96) of patients had pneumonia (78.1% bilateral), 59.9% (67) had lymphopenia (lymphocytes <1000/mL) and 31.3% (35) had p02 <90%. The variables for monitoring the clinical course are shown in table 1. Conclusion and relevance Mortality rate and mortality rate <30 days from admission were high. The clinical course in patients with active anticancer treatment was similar to that of all cancer patients. Larger series of patients are needed to continue studying outcomes of SARS-CoV2 infection in cancer patients. (Table Presented).