Mortality and Severity in COVID-19 Patients on ACEIs and ARBs—A Systematic Review, Meta-Analysis, and Meta-Regression Analysis

Frontiers in Medicine

Kiran S. Mahapure¹  Ishita Mehra²  Vikas Bansal³  Rahul Kashyap⁴  Aysun Tekin⁴  Romil Singh⁴  Mack Sheraton⁵  Prithwish Ghosh⁶  Abhishek Bhurwal⁷  Hira Khan⁸  Fnu Ayesha⁹  Sawai Singh Rathore^1,10  Janaki Makadia^1,11  Sohini Anand^1,12 

[1] 0Department of Plastic Surgery, KAHER J. N. Medical College, Belgaum, India;1Department of Internal Medicine, North Alabama Medical Center, Florence, AL, United States;2Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States;Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States;Department of Emergency Medicine, Trinity West Medical Center, Steubenville, OH, United States;Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States;Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States;Department of Internal Medicine, Islamic International Medical College, Rawalpindi, Pakistan;Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan;Dr. Sampurnanand Medical College and Hospital, Jodhpur, India;GMERS Medical College and Hospital, Vadodara, India;Patliputra Medical College and Hospital, Dhanbad, India;

关键词: COVID-19;    Angiotensin inhibitors;    ACEI;    ARB;    mortality;    severity;   

DOI  :  10.3389/fmed.2021.703661

来源: DOAJ

【 摘 要 】

Purpose: The primary objective of this systematic review is to assess association of mortality in COVID-19 patients on Angiotensin-converting-enzyme inhibitors (ACEIs) and Angiotensin-II receptor blockers (ARBs). A secondary objective is to assess associations with higher severity of the disease in COVID-19 patients.Materials and Methods: We searched multiple COVID-19 databases (WHO, CDC, LIT-COVID) for longitudinal studies globally reporting mortality and severity published before January 18th, 2021. Meta-analyses were performed using 53 studies for mortality outcome and 43 for the severity outcome. Mantel-Haenszel odds ratios were generated to describe overall effect size using random effect models. To account for between study results variations, multivariate meta-regression was performed with preselected covariates using maximum likelihood method for both the mortality and severity models.Result: Our findings showed that the use of ACEIs/ARBs did not significantly influence either mortality (OR = 1.16 95% CI 0.94–1.44, p = 0.15, I2 = 93.2%) or severity (OR = 1.18, 95% CI 0.94–1.48, p = 0.15, I2 = 91.1%) in comparison to not being on ACEIs/ARBs in COVID-19 positive patients. Multivariate meta-regression for the mortality model demonstrated that 36% of between study variations could be explained by differences in age, gender, and proportion of heart diseases in the study samples. Multivariate meta-regression for the severity model demonstrated that 8% of between study variations could be explained by differences in age, proportion of diabetes, heart disease and study country in the study samples.Conclusion: We found no association of mortality or severity in COVID-19 patients taking ACEIs/ARBs.

【 授权许可】

Unknown