Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARB) Are Protective Against ICU Admission and Mortality for Patients With COVID-19 Disease

Abstract

Introduction: Corona Virus disease 2019 (COVID-19) caused by the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic. The aim of this study was to investigate the impact of being on an Angiotensin-Converting Enzyme Inhibitors (ACEI) and/or Angiotensin Receptor Blockers (ARB) on hospital admission, on the following COVID-19 outcomes: disease severity, ICU admission, and mortality.Methods: The charts of all patients consecutively diagnosed with COVID-19 from the 24th of February to the 16th of June of the year 2020 in Jaber Al-Ahmed Al-Sabah hospital in Kuwait were checked. All related patient information and clinical data was retrieved from the hospitals electronic medical record system. The primary outcome was COVID-19 disease severity defined as the need for Intensive Care Unit (ICU) admission. Secondary outcome was mortality.Results: A total of 4,019 COVID-19 patients were included, of which 325 patients (8.1%) used ACEI/ARB, users of ACEI/ARB were found to be significantly older (54.4 vs. 40.5 years). ACEI/ARB users were found to have more co-morbidities; diabetes (45.8 vs. 14.8%) and hypertension (92.9 vs. 13.0%). ACEI/ARB use was found to be significantly associated with greater risk of ICU admission in the unadjusted analysis [OR, 1.51 (95% CI: 1.04–2.19), p = 0.028]. After adjustment for age, gender, nationality, coronary artery disease, diabetes and hypertension, ICU admission was found to be inversely associated with ACEI use [OR, 0.57 (95% CI: 0.34–0.88), p = 0.01] and inversely associated with mortality [OR, 0.56 (95% CI: 0.33–0.95), p = 0.032].Conclusion: The current evidence in the literature supports continuation of ACEI/ARB medications for patients with co-morbidities that acquire COVID-19 infection. Although, the protective effects of such medications on COVID-19 disease severity and mortality remain unclear, the findings of the present study support the use of ACEI/ARB medication.

RAAS, ACE2 and COVID-19; a mechanistic review

“…In a recent study aimed to investigate the impact of ACEIs/ARBs use on the hospital admission time of COVID-19 patients and the disease outcomes (disease severity, ICU admission, and mortality), the authors reported that ICU admission and COVID-19 mortality rates were inversely associated with ACEIs/ARBs use ( ElAbd et al, 2021 ).…”

Effect of ACE2 Expression Inhibiting Drugs on COVID-19 Disease Severity, Outcome and Length of Admission in Ethiopian Patients: A Causal Inference Using Marginal Structural Model with Inverse Probability Weight

“…On the contrary, a study conducted in Turkey and Saudi Arabia reported that ACEIs and ARBs therapy were associated with higher risk of severe or critical COVID-19 disease, need of ICU care and higher incidence of in-hospital death [11,12]. As opposed to this, a study conducted in Kuwait showed that use of ACEIs and ARBs is inversely associated with ICU admission and mortality implying that these drugs have a protective effect from adverse disease outcome [13]. ACEIs, ARB s and NSAIDs are widely used drugs for the treatment of chronic conditions which are a problem of the developing countries, as much as it is a developed countries problem, showing an increasing trend in recent years with a larger proportion (77%) of deaths reported from low-and middleincome countries [14].…”

“…Among the study participants, 900 (95.2%) were discharged improved and the rest 45 (4.8%) died. The median length of admission was 14.0 days (IQR,(13)(14)(15)(16). Multinomial Logistic Regression, Log Binomial Regression and Negative Binomial Regression models were tted to assess the effect of ACEIs, ARBs and/or NSAIDs use on disease severity, outcome and length of admission respectively.…”

COVID-19 and SARS-CoV-2 Variants: Current Challenges and Health Concern

“…In patients from China with no reported underlying medical problems, there was an overall case fatality of 0.9 percent. In patients with comorbidity, case fatality was found to be greater: 10.5% in patients with cardiovascular disease, 7.3% in patients with diabetes, and around 6% in patients with chronic respiratory disease or cancer (Guan et al, 2020;Abdelhafiz et al, 2021;Bae et al, 2021;ElAbd et al, 2021). It has been also associated with depressive and Anxiety Symptoms of Healthcare Workers (Peng et al, 2021).…”