ACE inhibitors, angiotensin receptor blockers and endothelial injury in COVID-19.
J Intern Med
; 289(5): 688-699, 2021 05.
Article
in English
| MEDLINE | ID: covidwho-934019
ABSTRACT
BACKGROUND:
COVID-19 is caused by the coronavirus SARS-CoV-2, which uses angiotensin-converting enzyme 2 (ACE-2) as a receptor for cellular entry. It is theorized that ACE inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) may increase vulnerability to SARS-CoV-2 by upregulating ACE-2 expression, but ACE-I/ARB discontinuation is associated with clinical deterioration.OBJECTIVE:
To determine whether ACE-I and ARB use is associated with acute kidney injury (AKI), macrovascular thrombosis and in-hospital mortality.METHODS:
A retrospective, single-centre study of 558 hospital inpatients with confirmed COVID-19 admitted from 1 March to 30 April 2020, followed up until 24 May 2020. AKI and macrovascular thrombosis were primary end-points, and in-hospital mortality was a secondary end-point.RESULTS:
AKI occurred in 126 (23.1%) patients, 34 (6.1%) developed macrovascular thrombi, and 200 (35.9%) died. Overlap propensity score-weighted analysis showed no significant effect of ACE-I/ARB use on the risk of occurrence of the specified end-points. On exploratory analysis, severe chronic kidney disease (CKD) increases odds of macrovascular thrombi (OR 8.237, 95% CI 1.689-40.181, P = 0.009). The risk of AKI increased with advancing age (OR 1.028, 95% CI 1.011-1.044, P = 0.001) and diabetes (OR 1.675, 95% CI 1.065-2.633, P = 0.025). Immunosuppression was associated with lower risk of AKI (OR 0.160, 95% CI 0.029-0.886, P = 0.036). Advancing age, dependence on care, male gender and eGFR < 60 mL min-1 /1.73 m2 increased odds of in-hospital mortality.CONCLUSION:
We did not identify an association between ACE-I/ARB use and AKI, macrovascular thrombi or mortality. This supports the recommendations of the European and American Societies of Cardiology that ACE-Is and ARBs should not be discontinued during the COVID-19 pandemic.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Thrombosis
/
Angiotensin-Converting Enzyme Inhibitors
/
Renal Insufficiency, Chronic
/
Acute Kidney Injury
/
Angiotensin Receptor Antagonists
/
COVID-19
/
Hypertension
Type of study:
Diagnostic study
/
Observational study
/
Prognostic study
Limits:
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
Europa
Language:
English
Journal:
J Intern Med
Journal subject:
Internal Medicine
Year:
2021
Document Type:
Article
Affiliation country:
Joim.13202
Similar
MEDLINE
...
LILACS
LIS