Association between renin–angiotensin–aldosterone system inhibitor treatment, neutrophil–lymphocyte ratio, D-Dimer and clinical severity of COVID-19 in hospitalized patients: a multicenter, observational study

Abstract

The aim of this study was to investigate the possible relationship between worse clinical outcomes and the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in hospitalized COVID-19 patients. A total of 247 adult patients (154 males, 93 females; mean age: 51.3 ± 14.2 years) hospitalized for COVID-19 as confirmed by polymerase chain reaction (PCR) were retrospectively reviewed. Demographic and clinical characteristics and laboratory parameters were analyzed using various statistical modeling. Primary outcomes were defined as the need for intensive care unit (ICU), mechanical ventilation, or occurrence of death. Of the patients, 48 were treated in the ICU with a high flow oxygen/noninvasive mechanical ventilation (NIMV, n = 12) or mechanical ventilation ( n = 36). Median length of ICU stay was 13 (range, 7–18) days. Mortality was seen in four of the ICU patients. Other patients were followed in the COVID-19 services for a median of 7 days. There was no significant correlation between the primary outcomes and use of ACEIs/ARBs (frequentist OR = 0.82, 95% confidence interval (CI) 0.29–2.34, p = 0.715 and Bayesian posterior median OR = 0.80, 95% CI 0.31–2.02) and presence of hypertension (frequentist OR = 1.23, 95% CI 0.52–2.92, p = 0.631 and Bayesian posterior median OR = 1.25, 95% CI 0.58–2.60). Neutrophil-to-lymphocyte ratio (NLR) and D-dimer levels were strongly associated with primary outcomes. In conclusion, the presence of hypertension and use of ACEIs/ARBs were not significantly associated with poor primary clinical outcomes; however, NLR and D-dimer levels were strong predictors of clinical worsening.

Association Between Renin-Angiotensin-Aldosterone System Inhibitors and Clinical Outcomes in Patients With COVID-19

“…Similar results were observed in multiple small retrospective cohort studies. 29 , 36 , 42 , 54 It is worth noting that most studies included in the meta-analyses were retrospective and observational; with these study designs, unmeasured confounding factors and potential biases are inevitable. In addition, patients receiving ACEIs/ARBs are more likely to have heart failure, cardiovascular disease, hypertension, and comorbidities, which are associated with an increased risk of death among patients with COVID-19.…”

A comprehensive guide to the pharmacologic regulation of angiotensin converting enzyme 2 (ACE2), the SARS-CoV-2 entry receptor

“…In recent months, several clinical studies have reported that the use of ARBs and ACE-Inhs. does not affect disease progression and mortality rates in COVID-19 patients ( Anzola et al, 2020 ; Bae et al, 2020 ; Braude et al, 2020 ; Cordeanu et al, 2020 ; H. Cui et al, 2020 ; Di Castelnuovo et al, 2020 ; Gormez et al, 2020 ; Hippisley-Cox et al, 2020 ; Kalra et al, 2020 ; Khan et al, 2020 , Kim et al, 2020 ; Kocayigit et al, 2020 ; Lafaurie et al, 2020 ; J. Lee et al, 2020 ; Sardu et al, 2020 ; Soleimani et al, 2020 , Taher et al, 2020 ; Trifirò et al, 2020 , Wang et al, 2020 ). Altogether, these results indicate that the use of ACE-Inhs.…”

Prognostic value of neutrophil‐to‐lymphocyte ratio in COVID‐19 patients: A systematic review and meta‐analysis

“…For this systematic review, 58 cohort studies and three case-control studies were included, most of them conducted in China and 20 studies in other countries. On the other hand, our primary outcome (severity) was present in 36 studies, [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] the secondary outcome (mortality)…”