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. 2020 Oct 28;9(11):3472.
doi: 10.3390/jcm9113472.

Outcomes of COVID-19 Hospitalized Patients Previously Treated with Renin-Angiotensin System Inhibitors

Elena-Mihaela Cordeanu  1 , Lucas Jambert  2 , Francois Severac  3 , Hélène Lambach  1 , Jonathan Tousch  1 , Marie Heitz  1 , Corina Mirea  1 , Amer Hamadé  2 , Waël Younes  4 , Anne-Sophie Frantz  1 , Hamid Merdji  5 , Valérie Schini-Kerth  6 , Pascal Bilbault  7 , Ferhat Meziani  5 , Patrick Ohlmann  8 , Emmanuel Andres  9 , Dominique Stephan  1
Affiliations

Outcomes of COVID-19 Hospitalized Patients Previously Treated with Renin-Angiotensin System Inhibitors

Elena-Mihaela Cordeanu et al. J Clin Med. .

Abstract

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates respiratory epithelium through angiotensin-converting enzyme-2 binding, raising concerns about the potentially harmful effects of renin-angiotensin system inhibitors (RASi) on Human Coronavirus Disease 2019 (COVID-19) evolution. This study aimed to provide insight into the impact of RASi on SARS-CoV-2 outcomes in patients hospitalized for COVID-19. (2) Methods: This was a retrospective analysis of hospitalized adult patients with SARS-CoV-2 infection admitted to a university hospital in France. The observation period ended at hospital discharge. (3) Results: During the study period, 943 COVID-19 patients were admitted to our institution, of whom 772 were included in this analysis. Among them, 431 (55.8%) had previously known hypertension. The median age was 68 (56-79) years. Overall, 220 (28.5%) patients were placed under mechanical ventilation and 173 (22.4%) died. According to previous exposure to RASi, we defined two groups, namely, "RASi" (n = 282) and "RASi-free" (n = 490). Severe pneumonia (defined as leading to death and/or requiring intubation, high-flow nasal oxygen, noninvasive ventilation, and/or oxygen flow at a rate of ≥5 L/min) and death occurred more frequently in RASi-treated patients (64% versus 53% and 29% versus 19%, respectively). However, in a propensity score-matched cohort derived from the overall population, neither death (hazard ratio (HR) 0.93 (95% confidence interval (CI) 0.57-1.50), p = 0.76) nor severe pneumonia (HR 1.03 (95%CI 0.73-1.44), p = 0.85) were associated with RASi therapy. (4) Conclusion: Our study showed no correlation between previous RASi treatment and death or severe COVID-19 pneumonia after adjustment for confounders.

Keywords: COVID-19; SARS-CoV-2; angiotensin II receptor blocker; angiotensin-converting enzyme; propensity score; renin–angiotensin system inhibitor.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart showing patient selection. h: Hours; Feb: February; RAS: Renin–angiotensin system; RASi: Renin–angiotensin system inhibitor(s).
Figure 2
Figure 2
Crude (A) and propensity score-weighted (B) survival according to previous RASi use. CI: Confidence interval; HR: Hazard ratio; RASi: Renin–angiotensin system inhibitors.
Figure 3
Figure 3
Crude (A) and propensity score-weighted (B) event-free survival for severe pneumonia according to previous RASi use. CI: Confidence interval; HR: Hazard ratio; RASi: Renin–angiotensin system inhibitors.
See this image and copyright information in PMC

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