This study investigated continued and discontinued use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) during hospitalization of 614 hypertensive laboratory-confirmed COVID-19 patients. Demographics, comorbidities, vital signs, and laboratory data and ACEi/ARB usage were analyzed. To account for confounders, patients were sub-stratified by whether they developed hypotension and acute kidney injury (AKI) during the index hospitalization. Mortality (22% vs 17%, p>0.05) and intensive-care-unit (ICU) admission (26% vs 12%, p>0.05) rates were not significantly different between non-ACEi/ARB and ACEi/ARB groups. However, patients who continued ACEi/ARBs in the hospital had markedly lower ICU admission rate (12% vs 26%, p=0.001, OR=0.347 [95% CI:0.187-0.643]) and mortality rate (6% vs 28%, p=0.001, OR=0.215 [95% CI:0.101-0.455]) compared to patients who discontinued ACEi/ARB. The odds ratio for mortality remained significantly lower after accounting for development of hypotension or AKI. These findings suggest that continued ACEi/ARB use in hypertensive COVID-19 patients yields better clinical outcomes.
e73providers to be compared with infection incidence in the community.To date there are no reported clusters of respiratory-transmitted diseases, including severe acute respiratory syndrome coronavirus and SARS-CoV-2, in dental providers or patients in a dental setting.We declare no competing interests.
Objectives During the summer of 2021, case reports began to emerge documenting a small number of individuals who developed autoimmune hepatitis (AIH) following COVID-19 vaccination. These cases are rare and novel, and very little is known. In our systematic review, we analyzed every published case of AIH and reviewed their characteristic findings, treatment, and outcomes. Methods We searched PubMed, Embase, and Web of Science from December 1, 2019, to November 1, 2021. Two researchers independently extracted information from the articles about vaccine type, patient history, laboratory values, histology results, treatment regimens, and disease course. Results Thirty-two patients developed AIH-like syndromes after receiving a COVID-19 vaccine. Jaundice was the most frequently reported symptom (81%), and 19% of patients were initially asymptomatic and presented with elevated liver enzymes found during routine bloodwork. Mean alanine transaminase, aspartate transaminase, and total bilirubin were 1231 U/L, 921 U/L, and 14 mg/dL, respectively. Anti-nuclear antibody was positive in 56%, and anti-smooth muscle antibody in 28% of patients. Steroids were used in 75% of patients. Improvement or complete resolution was seen in 97% of patients. One patient died despite aggressive steroid treatment. Conclusion COVID-19 vaccine-induced AIH is an uncommon association with just 32 documented cases in the literature. Clinicians should be vigilant for AIH in patients who present with liver injury following vaccination. These new findings should under not deter individuals from getting vaccinated, as the benefits of vaccination far outweigh the risks. Fortunately, COVID-19 vaccine-induced AIH appears amendable to corticosteroid therapy and appears to have a favorable outcome.
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