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Association Between Baseline Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and Death Among Patients Tested for COVID-19.
Thomas, Sarah A; Puskarich, Michael; Pulia, Michael S; Meltzer, Andrew C; Camargo, Carlos A; Courtney, D Mark; Nordenholz, Kristen E; Kline, Jeffrey A; Kabrhel, Christopher.
  • Thomas SA; BSc Medical Biosciences Candidate, Faculty of Medicine, Imperial College London, London, UK.
  • Puskarich M; Hennepin Healthcare, Minneapolis, Minnesota, USA.
  • Pulia MS; Departments of Emergency Medicine and Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA.
  • Meltzer AC; GWU School of Medicine & Health Sciences, Department of Emergency Medicine, Washington, DC, USA.
  • Camargo CA; Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Courtney DM; Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
  • Nordenholz KE; University of Colorado School of Medicine, Aurora, Colorado, USA.
  • Kline JA; Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA.
  • Kabrhel C; Center for Vascular Emergencies, Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Clin Pharmacol ; 62(6): 777-782, 2022 06.
Article in English | MEDLINE | ID: covidwho-1589060
ABSTRACT
Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) drugs may modify risk associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, we assessed whether baseline therapy with ACEIs or ARBs was associated with lower mortality, respiratory failure (noninvasive ventilation or intubation), and renal failure (new renal replacement therapy) in SARS-CoV-2-positive patients. This retrospective registry-based observational cohort study used data from a national database of emergency department patients tested for SARS-CoV-2. Symptomatic emergency department patients were accrued from January to October 2020, across 197 hospitals in the United States. Multivariable analysis using logistic regression evaluated end points among SARS-CoV-2-positive cases, focusing on ACEIs/ARBs and adjusting for covariates. Model performance was evaluated using the c statistic for discrimination and Cox plotting for calibration. A total of 13 859 (99.9%) patients had known mortality status, of whom 2045 (14.8%) died. Respiratory failure occurred in 2485/13 880 (17.9%) and renal failure in 548/13 813 (4.0%) patients with available data. ACEI/ARB status was associated with a 25% decrease in mortality odds (odds ratio [OR], 0.75; 95%CI, 0.59-0.94; P = .011; c = .82). ACEIs/ARBs were not significantly associated with respiratory failure (OR, 0.89; 95%CI, 0.78-1.06; P = .206) or renal failure (OR, 0.75; 95%CI, 0.55-1.04; P = .083). Adjusting for covariates, baseline ACEI/ARB was associated with 25% lower mortality in SARS-CoV-2-positive patients. The potential mechanism for ACEI/ARB mortality modification requires further exploration.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Insufficiency / Renal Insufficiency / COVID-19 Drug Treatment Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Male Language: English Journal: J Clin Pharmacol Year: 2022 Document Type: Article Affiliation country: Jcph.2015

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Insufficiency / Renal Insufficiency / COVID-19 Drug Treatment Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Male Language: English Journal: J Clin Pharmacol Year: 2022 Document Type: Article Affiliation country: Jcph.2015