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?:abstract
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The association between angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) and the risk of mortality in hospitalized patients with severe coronavirus disease 2019 (COVID-19) was investigated This retrospective cohort study was performed in all hospitalized patients with COVID-19 in tertiary hospitals in Daegu, Korea Patients were classified based on whether they received ACE-I or ARB before COVID-19 diagnosis The analysis of the primary outcome, in-hospital mortality, was performed using the Cox proportional hazards regression model Of 130 patients with COVID-19, 30 (23 1%) who received ACE-I or ARB exhibited an increased risk of in-hospital mortality (adjusted hazard ratio, 2 20;95% confidence interval [CI], 1 10-4 38;P = 0 025) ACE-I or ARB was also associated with severe complications, such as acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR], 2 58;95% CI, 1 02-6 51;P = 0 045) and acute kidney injury (AKI) (aOR, 3 06;95% CI, 1 15-8 15;P = 0 026) Among the patients with ACE-I or ARB therapy, 8 patients (26 7%) used high equivalent doses of ACE-I or ARB and they had higher in-hospital mortality and an increased risk of ARDS and AKI (all, P < 0 05) ACE-I or ARB therapy in patients with severe COVID-19 was associated with the occurrence of severe complications and increased in-hospital mortality The potentially harmful effect of ACE-I or ARB therapy may be higher in patients who received high doses
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