ABSTRACT
Background: Kidney dysfunction is a prevalent disease that leads to many complications over time, such as hypertension, heart disease, and death. ACEI/ARBs are known to be renoprotective. However, few studies describe the association between ACEI/ARB use and kidney dysfunction in patients with SARS-CoV-2 infection. Purpose(s): To explore the association between patients with SARS-CoV- 2 and kidney dysfunction in patients taking an ACEI/ARB. We hypothesize a negative association between patients with SARS-CoV-2 taking an ACEI/ARB and kidney dysfunction. Method(s): A retrospective query between March 2020 and April 2021 was performed in patients 18 years and older who tested positive for SARSCoV- 2 using a polymerase chain reaction test. Patients were divided into two groups: Kidney dysfunction and no kidney dysfunction. Kidney dysfunction was defined as any diagnosis of chronic kidney disease or acute kidney injury. Primary outcomes were all-cause mortality and hospitalization rate. Secondary outcomes included myocardial infarction (MI), hypotension, intubation, vasopressor use, ventricular tachycardia, and ventricular fibrillation. We used multivariate logistic regression to adjust for baseline characteristics. Result(s): We identified 996 patients with kidney dysfunction and 22,106 without kidney dysfunction who tested positive for SARS-CoV-2. The incidence was 258 (25.9%) for ACEI/ARB use in patients with kidney dysfunction. Adjusted odds ratio (OR) for patients with kidney dysfunction was 5.705 (95% Confidence Interval [CI]: 4.554-7.146;p<0.001) for hospitalization, 0.895 (95% CI: 0.707-1.135;p<0.361) for patients taking ACEI/ARB, and 0.529 (95% CI: 0.333-0.838;<0.007) for mortality in patients with kidney dysfunction who took ACEI/ARB. All secondary outcomes had significantly greater adjusted OR (p<0.001), except for MI (p<0.339), ventricular tachycardia (p<0.697), and ventricular fibrillation (p<0.060). Conclusion(s): To date, the benefits of ACEI/ARB in SARS-CoV-2 patients have been controversial. While ACEI/ARB is known to have renoprotective properties, we did not find a significant association between ACEI/ARB and kidney dysfunction in patients with SARS-CoV-2. However, we found the use of ACEI/ARB in patients with kidney dysfunction to be associated with lower mortality. Therefore, clinicians should continue using this medication for its mortality benefits in patients with kidney dysfunction and its cardioprotective effects.
ABSTRACT
Background: SARS-CoV-2 infection affects the cardiovascular system and can result in vascular dysregulation and dysfunction. However, the hospitalization rates due to pre-existing cardiovascular disease and concomitant SARS-CoV-2 infection are not fully known. Purpose: To further elucidate the association between hospitalization and SARS-CoV-2 patients with pre-existing cardiovascular disease. We hypothesize that pre-existing cardiovascular disease is positively associated with hospitalization in patients who test positive for SARS-CoV-2. Methods: This is a retrospective study of patients 18 years and older who tested positive for SARS-CoV-2 between March 2020 and April 2021. Patients with cardiovascular co-morbidities, specifically hypertension, coronary artery disease (CAD), heart failure, were analyzed. The primary outcome was hospitalization. Secondary outcomes were all-cause mortality, myocardial infarction (MI), vasopressor use, hypotension, intubation, and acute kidney injury. Multivariate logistic regression analysis adjusted for demographics and comorbidities. Results: We identified 23,076 patients who tested positive for SARS-CoV-2;the hospitalization rate was 11.8% (2,721 patients). The incidence was 722 (26.5%) for CAD, 2068 (76%) for hypertension, 534 (91.3%) for heart failure, 188 (6.9%) for ESRD, 1484 (58.6%) for diabetes in patients who were hospitalized. The adjusted odds ratio (OR) of hospitalization was of 1.54 (95% Confidence Interval [CI]: 1.112–2.125;p<0.009) in patients with CAD, 5.730 (95% CI: 4.685–7.009;p<0.001) in patients with hypertension, 3.639 (95% CI: 2.308–5.737;p<0.001) in patients with heart failure. Use of angiotensin-converting enzyme inhibitor (ACEI) (p<0.001) was associated with reduced hospitalization, while the use of hydralazine (p<0.001), beta-blockers (p<0.001), and calcium channel blockers (p<0.001) were associated with increased hospitalization. Conclusion: SARS-CoV-2 positive patients with CAD, hypertension or heart failure were associated with increased hospitalization. Admitted patients were more likely to be taking calcium channel blockers, beta-blockers, and hydralazine. In contrast, these patients were also less likely to be taking ACEI. Funding Acknowledgement: Type of funding sources: None.
ABSTRACT
Background The presence of cardiovascular comorbidities is known to cause increased mortality. However, it is unclear how different cardiovascular comorbidities affect the mortality among patients with SARS-CoV-2. Methods This was a retrospective study of patients 18 years and older with a positive SARS-CoV-2 infection confirmed with polymerase chain reaction test at a public hospital in New York City between March 2020 and April 2021. Different cardiovascular comorbidities, including hypertension, heart failure, and coronary artery disease (CAD), and their effects on the patients with SARS-CoV-2 infection were analyzed. Multivariate logistic regression analyses adjusted for demographics and comorbidities. Results We identified 23,076 patients with a positive SARS-CoV-2 test;The rate of death was 3.0% (703 patients). Of those patients, 631 (89.8%) had hypertension, 266 (37.8%) had CAD, 104 (14.8%) had end-stage renal disease, 74 (10.5%) experienced a myocardial infarction (MI), 442 (62.9%) had diabetes, and 212 (30.2%) had heart failure. The adjusted odds of death was 2.34 (95% Confidence Interval [CI]: 1.59-3.44;p<0.001) for patients with hypertension, 1.43 (95% CI: 1.08-1.88;p<0.013) for patients with heart failure, 0.97 (95% CI: 0.73-1.29;p<0.843) for patients with CAD, 0.227 (95% CI: 0.146-0.351;p<0.001) for patients taking ACE inhibitors, 0.921 (CI: 0.702-1.208;p<0.550) for patients with diabetes, 1.207 (95% CI: 0.724-2.010;p<0.470) for patients with end stage renal disease, and 0.740 (95% CI: 0.431-1.270;<0.274) for patients who experience a MI. Conclusion This retrospective study suggests that cardiovascular comorbidities, specifically hypertension and heart failure, were associated with the increased risk of mortality in patients with SARS-CoV-2, while CAD and MI were not. As with most observational studies, potential residual confounding may not confirm casualty.
ABSTRACT
Introduction: Hypertension (HTN) is associated with cardiovascular mortality risk. The risk of mortality or hospitalization amongst COVID-19 patients with HTN remains unclear. Hypothesis: There is increased risk of hospitalization and mortality amongst COVID-19 patients with HTN. Methods: The electronic health database at Coney Island Hospital was queried retrospectively for a cohort of patients, 18 or older, between 3/1/2020 and 4/1/2020. We included SARS-CoV-2 positive patients divided into two groups, hypertensive and non-hypertensive. We examined baseline characteristics including comorbidities. The primary outcomes were all-cause mortality and hospitalization. The secondary outcomes were acute kidney injury, ventricular arrhythmia, myocardial infarction, heart failure, and intubation. We also examined the use of antihypertensives. Results: We identified 23,102 patients positive for SARS-CoV-2;3,507 with HTN and 19,595 without. Patients in the HTN group had a higher incidence of underlying comorbidities (p<0.001). The mean age in years was 64.69 +-16.2 (SEM 0.109) and 41.9+-15.3, (SEM 0.273) for HTN and non-HTN respectively (p<0.117). The unadjusted odds of death, OR 59.54 (46.51-76.22), p<0.001, and hospitalization, OR 41.781 (37.6-46.2), p<0.001, were significantly higher in the HTN group, however only hospitalization was significantly higher in the HTN group, OR 8.86 (7.61-10.32), p<0.001, when adjusted for comorbidities using multivariate logistic regression;mortality was not significant, OR 1.16 (0.83-1.62), p=0.391. For the secondary outcomes, hypertensive patients had significantly increased unadjusted odds of all outcomes (p<0.001). Discussion: In this cohort of patients, the unadjusted odds of death for COVID19 patients with HTN is significantly increased compared to non-hypertensive patients. Despite the increased age, using multivariate logistic regression, we found that HTN does not significantly increase mortality. Hospitalization remains significantly elevated with multivariate regression in hypertensive patients. Conclusions: This retrospective cohort study suggests that HTN alone does not increase the odds of death amongst COVID-19 patients, however hospitalization may be increased.