Meta-analysis of the association between angiotensin pathway inhibitors and COVID-19 severity and mortality

Systematic Reviews

Aaron Drovandi¹  Malindu E. Fernando²  Jonathan Golledge³ 

[1] Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia;Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia;Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia;Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia;Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia;Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia;

关键词: 2019 novel coronavirus disease;    Angiotensin-converting enzyme inhibitors;    Angiotensin receptor blockers;    COVID-19;   

DOI  :  10.1186/s13643-021-01802-6

来源: Springer

【 摘 要 】

BackgroundConflicting findings and the analysis of unpublished and retracted data have led to controversy on the safety of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in people with COVID-19 infection. This meta-analysis examined the association of prescription of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) with the outcome from COVID-19.MethodsA systematic search was conducted to find published studies that reported the outcome of COVID-19 in relation to prescription of ACEI or ARB. Two authors (MF and AD) independently screened and extracted data and assessed study quality and strength of association using standardised tools. The endpoints for the meta-analyses were severe or critical disease outcome and mortality based on standardised criteria.ResultsTwenty-six studies including 8389 people prescribed ACEI or ARB and 20,989 people not prescribed these medications were included. The quality of studies varied, and the overall strength of association was poor with a high risk of confounding bias. Patients prescribed ACEI or ARB had a greater prevalence of risk factors. Meta-analysis found an association between prescription of ACEI or ARB with severe or critical disease outcome (risk ratio, RR, 1.23, 95% confidence interval, CI, 1.06 to 1.42, p = 0.006, I2 = 88%) but this association was lost in sensitivity analyses. There was no association between ACEI or ARB prescription and mortality (RR 1.18, 95% CI 0.92 to 1.50, p = 0.19, I2 = 82%).ConclusionsThis meta-analysis suggests that people prescribed ACEI or ARB more commonly had severe or critical disease outcome, but not mortality, in published cohorts of patients diagnosed with COVID-19. This finding is most likely due to a greater prevalence of risk factors in these patients rather than due to exposure to angiotensin pathway inhibitors.

【 授权许可】

CC BY