Background and aims Hypertension is associated with an increased risk of severe outcomes with COVID-19 disease. Angiotensin Converting Enzyme (ACE) inhibitors are widely used as a first line medication for the treatment of hypertension in the UK, although their use was suggested in early reports to increase the risk associated with SARS-CoV-2 infection. Methods A prospective cohort study of hospitalised patients with laboratory confirmed COVID-19 was conducted across three hospital sites with patients identified on the 9th April 2020. Demographic and other baseline data were extracted from electronic case records, and patients grouped depending on ACE inhibitor usage or not. The 60-day all-cause mortality and need for intubation compared. Results Of the 173 patients identified, 88 (50.8%) had hypertension. Of these 27 (30.7%) used ACE inhibitors. We did not find significant differences in 60-day all-cause mortality, the requirement for invasive ventilation or length of stay between our patient cohorts after adjusting for covariates. Conclusion This study contributes to the growing evidence supporting the continued use of ACE inhibitors in COVID-19 disease, although adequately powered randomised controlled trials will be needed to confirm effects.
Introduction The host systemic inflammatory response (SIR) is prognostic in a wide variety of solid tumours, with a greater degree of inflammation being associated with a worse clinical outcome. Neutrophil Lymphocyte Ratio (NLR) is an established way to measure SIR in vivo. We aimed to establish whether preoperative NLR correlates with infective complications in patients undergoing colorectal cancer (CRC) resection. Methods Data was extracted retrospectively for all CRC resections over a 2 year period (2016-2018) at a single district general hospital. NLR was measured for each patient from bloods at the time of pre-operative assessment. Post-operative complications were recorded using the Clavien-Dindo classification and subsequently classified as infective and non-infective. A Two-tailed Mann-Whitney U test was used to evaluate the data from an online resource. Results Of the 131 patients, 49 had complications of which 20 were infective. Of total complications 58% were male and 35% were aged 75 years or older. Current or ex-smokers constituted 43% and 41 of the total patients had a BMI >30 kg/m2. Pre-assessment mean NLR was 2.3 in those without complications and 4.7 in those with any complication. A mean NLR of 5.4 was present in those with infective complications, p-value 0.026. Conclusion This study found that a raised NLR was present preoperatively in those who developed infective complications following CRC resection. This is a simple, readily available and cost-effective method of identifying patients at risk of complication. This ultimately may be useful in highlighting patients who would benefit from enhanced pre-operative optimisation. Further research to validate these findings in larger studies would seem warranted.
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