The effect of RAAS inhibitors on acute hypoxemic respiratory failure and in-hospital mortality in the hypertensive Covid-19 patients

ABSTRACT

Introduction

We have aimed to investigate the relationship between use of angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin-receptor-blocker (ARB) drugs and acute hypoxemic respiratory failure (AHRF) and in-hospital mortality in hypertensive Covid-19 patients.

Material and method

Consecutive 1345 patients diagnosed with Covid-19 between April and October 2020 who met inclusion criteria were divided into two groups based on presence and absence of AHRF and mortality. The groups were compared regarding epidemiological, clinical, radiological, laboratory findings and treatments methods. The patient groups ACEI, ARB and other antihypertensive drugs (non-ACEI/ARB) were compared regarding same parameters.

Results

Median age was 68 (60–76) years in the patient group including 805 (59.9.1%) females. Of the patients, 475 (35.3%), 644 (47.9%) and 226 (16.8%) were using ACEIs, ARBs and non-ACEI/ARB, respectively. AHRF and in-hospital mortality developed in 1053 (78.3%) and 290 (21.6%) patients, respectively. Age, gender, coronary artery disease, diabetes mellitus (DM), neutrophil, lymphocyte, creatinine, D-dimer, C-reactive protein (CRP), ACEI, beta blocker and aspartate transaminase (AST) found statistically significant in the univariable logistic regression performed to identify independent predictors of mortality were included multivariable logistic regression model. Age (OR: 1.066, 95%CI: 1.049–1.083; p < .001), DM (OR: 1.682, 95%CI: 1.238–2.286; p = .001), neutrophil (OR: 1.041, 95%CI: 1.007–1.077; p = .019), creatinine (OR: 1.178, 95%CI: 1.048–1.325; p = .006), CRP (OR: 1.008, 95%CI: 1.006–1.010; p < .001), ACEI (OR: 0.718, 95%CI: 0.521–0.988; p = .042), AST (OR: 1.005, 95%CI: 1.001–1.010; p = .010) were found associated with in-hospital mortality.

Conclusion

In our study, it was not detected clinically significant difference between three groups with regard to their relation with in-hospital mortality.

KEYWORDS:

• ACEI
• acute hypoxemic respiratory failure
• ARB
• Covid-19 infection
• hypertension
• in-hospital mortality

Disclosure statement

All authors declare that they do not have conflict of interest.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. The ethics committee approved the design of the present study. Informed consent was waived due to the retrospective design of the study.

Supplementary material

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Additional information

Funding

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.