TY - JOUR
T1 - Impact of renin–angiotensin–aldosterone system inhibition on mortality in critically ill COVID-19 patients with pre-existing hypertension
T2 - a prospective cohort study
AU - Sato, Kei
AU - White, Nicole
AU - Fanning, Jonathon P.
AU - Obonyo, Nchafatso
AU - Yamashita, Michael H.
AU - Appadurai, Vinesh
AU - Ciullo, Anna
AU - May, Meryta
AU - Worku, Elliott T.
AU - Helms, Leticia
AU - Ohshimo, Shinichiro
AU - Juzar, Dafsah A.
AU - Suen, Jacky Y.
AU - Bassi, Gianluigi Li
AU - Fraser, John F.
AU - Arora, Rakesh C.
AU - on behalf of the COVID-19 Critical Care Consortium
N1 - Funding Information:
This study received discretionary funding from University of Queensland, Wesley Medical Research, The Prince Charles Hospital Foundation, The Health Research Board of Ireland, Biomedicine international training research programme for excellent clinician-scientists, European Union’s research and innovation programme (Horizon 2020), and la Caixa Foundation. All of them have not and will not have any input into study design, data collection, data analysis or interpretation, or manuscript preparation.
Funding Information:
We appreciate all collaborative organizations including ISARIC/SPRINT-SARI and all investigators (Additional file 1 : Document S2) who registered patients’ data on behalf of the COVID-19 Critical Care Consortium. COVID-19 Critical Care Consortium Investigators Gianluigi Li Bassi MD1,2,15, PhD; Jacky Y. Suen BSc1,2, PhD; Heidi J. Dalton MD, MCCM16; John Laffey, MA, MD17; Daniel Brodie, MD18; Eddy Fan, MD, PhD19; Antoni Torres, MD, PhD, FERS ATS Fellow15,20; Davide Chiumello, MD21; Alyaa Elhazmi22; Carol Hodgson, PT, PhD23,24; Shingo Ichiba, MD25; Carlos Luna, MD26; Srinivas Murthy, MD27; Alistair Nichol, MD, PhD23,28; Pauline Yeung Ng, MD29; Mark Ogino, MD30; Eva Marwali, MD, PhD31; Ian Yang MBBS, PhD, FRACP32, Grad Dip Clin Epid, FAPSR, FThorSoc32; Giacomo Grasselli MD, PhD33,34; Robert Bartlett, MD35; Aidan Burrell, MBBS, PhD36,37; and John F. Fraser MBChB, PhD, FRCP(Glas), FFARCSI, FRCA, FCICM1,2,111Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland ,Australia,2Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia,3Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia,4Nuffield Department of Population Health, University of Oxford, United Kingdom,5Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom,6Initiative to Develop African Research Leaders/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya,7Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,8Department of cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia,9Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT 84132, USA,10Department of Microbiology, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia,11Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia,12Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan,13Intensive Cardiovascular Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia,14Division Intensive & emergency cardiovascular care, Department Cardiology and Vascular Medicine, Faculty of medicine, University of Indonesia, Jakarta, Indonesia,15'Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain,16INOVA Fairfax Medical Center, Heart and Vascular Institute, Falls Church VA, USA,17Anaesthesia and Intensive Care Medicine, Galway University Hospitals, and School of Medicine, National University of Ireland, Galway, Ireland,18Department of Medicine, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, NY, NY, USA,19Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada,20Servei de Pneumologia. Hospital Clinic de Barcelona, Barcelona, Spain,21Ospedale San Paolo, Milan, Italy,22Dr. Sulaiman Alhabib Medical Group - Research Center, Riyadh, Saudi Arabia,23Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia,24Department of Physiotherapy, Alfred Hospital, Melbourne, Australia,25Department of Clinical Engineering / Department of Intensive Care Medicine, Tokyo Women’s Medical University Hospital, Japan,26 División Neumonología, Hospital de Clínicas, UBA, Buenos Aires, Argentina,27Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada,28University College Dublin-Clinical Research Centre at St Vincent’s University Hospital, Dublin,29Division of Respiratory and Critical Care Medicine, The University of Hong Kong, Hong Kong, China,30Nemours Alfred I duPont Hospital for Children, Wilmington, DE,31National Cardiovascular Center Harapan Kita, Jakarta, Indonesia,32Thoracic Medicine Department, The Prince Charles Hospital, Brisbane, Australia,33Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,34Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy,35University of Michigan Medical Center, Ann Arbor, Michigan, USA,36Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,37Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/3/22
Y1 - 2022/3/22
N2 - Background: The influence of renin–angiotensin–aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients. Methods: Data from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included. A cohort of 737 COVID-19 patients with pre-existing hypertension admitted to intensive care units (ICUs) in 2020 were targeted. Multi-state survival analysis was performed to evaluate in-hospital mortality and hospital length of stay up to 90 days following ICU admission. Results: A total of 737 patients were included—538 (73%) with pre-existing hypertension had received ACEi/ARBs before ICU admission, while 199 (27%) had not. Cox proportional hazards model showed that previous ACEi/ARB use was associated with a decreased hazard of in-hospital death (HR, 0.74, 95% CI 0.58–0.94). Sensitivity analysis adjusted for propensity scores showed similar results for hazards of death. The average length of hospital stay was longer in ACEi/ARB group with 21.2 days (95% CI 19.7–22.8 days) in ICU and 6.7 days (5.9–7.6 days) in general ward compared to non-ACEi/ARB group with 16.2 days (14.1–18.6 days) and 6.4 days (5.1–7.9 days), respectively. When analysed separately, results for ACEi or ARB patient groups were similar for both death and discharge. Conclusions: In critically ill COVID-19 patients with comorbid hypertension, use of ACEi/ARBs prior to ICU admission was associated with a reduced risk of in-hospital mortality following adjustment for baseline characteristics although patients with ACEi/ARB showed longer length of hospital stay. Clinical trial registration The registration number: ACTRN12620000421932; The date of registration: 30, March 2020; The URL of the registration: https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12620000421932.
AB - Background: The influence of renin–angiotensin–aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients. Methods: Data from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included. A cohort of 737 COVID-19 patients with pre-existing hypertension admitted to intensive care units (ICUs) in 2020 were targeted. Multi-state survival analysis was performed to evaluate in-hospital mortality and hospital length of stay up to 90 days following ICU admission. Results: A total of 737 patients were included—538 (73%) with pre-existing hypertension had received ACEi/ARBs before ICU admission, while 199 (27%) had not. Cox proportional hazards model showed that previous ACEi/ARB use was associated with a decreased hazard of in-hospital death (HR, 0.74, 95% CI 0.58–0.94). Sensitivity analysis adjusted for propensity scores showed similar results for hazards of death. The average length of hospital stay was longer in ACEi/ARB group with 21.2 days (95% CI 19.7–22.8 days) in ICU and 6.7 days (5.9–7.6 days) in general ward compared to non-ACEi/ARB group with 16.2 days (14.1–18.6 days) and 6.4 days (5.1–7.9 days), respectively. When analysed separately, results for ACEi or ARB patient groups were similar for both death and discharge. Conclusions: In critically ill COVID-19 patients with comorbid hypertension, use of ACEi/ARBs prior to ICU admission was associated with a reduced risk of in-hospital mortality following adjustment for baseline characteristics although patients with ACEi/ARB showed longer length of hospital stay. Clinical trial registration The registration number: ACTRN12620000421932; The date of registration: 30, March 2020; The URL of the registration: https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12620000421932.
KW - Angiotensin receptor blockers
KW - Angiotensin-converting enzyme inhibitors
KW - COVID-19
KW - Critical care
KW - Severe acute respiratory syndrome coronavirus 2
UR - https://www.scopus.com/pages/publications/85126868034
U2 - 10.1186/s12872-022-02565-1
DO - 10.1186/s12872-022-02565-1
M3 - Article
C2 - 35321649
AN - SCOPUS:85126868034
SN - 1471-2261
VL - 22
JO - BMC Cardiovascular Disorders
JF - BMC Cardiovascular Disorders
IS - 1
M1 - 123
ER -