COVID-19 In-Hospital Mortality and Use of Renin-Angiotensin System Blockers in Geriatrics Patients

Abstract

Objective The role of treatment with renin-angiotensin-aldosterone system blockers at the onset of COVID-19 infection is not known in geriatric population. The aim of this study was to assess the relationship between angiotensin receptor blockers (ARB) and an ACE inhibitor (ACEI) use and in-hospital mortality in geriatric patients hospitalized for COVID-19. Design This observational retrospective study was conducted in a French geriatric department. Patients were included between March 17 and April 18, 2020. Setting and Participants: All consecutive 201 patients hospitalized for COVID-19 (confirmed by RT-PCR methods) were included. All non-deceased patients had 30 days of follow-up and no patient was lost to follow-up. Methods Demographic, clinical, biological data and medications were collected. In-hospital mortality of patients treated or not by ACEI/ARB was analyzed using multivariate Cox models. Results Mean age of the population was 86.3 (8.0) years old, 62.7% of patients were institutionalized, 88.6% had dementia and 53.5% had severe disability (ADL score < 2). Sixty-three patients were treated with ACEI/ARB and 138 were not. Mean follow-up was 23.4 (10.0) days, 66 (33.8%) patients died after an average of 10.0 days (6.0). Lower mortality rate was observed in patients treated with ACEI/ARB compared with patients not treated with ARB nor ACEI (22.2% (14) vs. 37.7% (52), HR = 0.54 (95% CI = 0.30-0.97), p=0.03). In a multivariate Cox regression model including age, sex, ADL score, Charlson index, renal function, dyspnea, CRP and white blood cells count, use of ACEI/ARB was significantly associated with lower in-hospital mortality (HR = 0.52 (0.27−0.99), p=0.048). Conclusion and Implications In very old subjects hospitalized in geriatric settings for COVID-19, mortality was significantly lower in subjects treated with ARB or ACEI prior to the onset of infection. The continuation of ACEI/ARB therapy should be encouraged during periods of coronavirus outbreak in older subjects.

Dementia as a mortality predictor among older adults with COVID-19: A systematic review and meta-analysis of observational study

“…A total of 8 studies were further removed because they were not original articles, 2 studies were removed because the population was not in older adults with dementia who have COVID-19, 19 studies were removed because they didn't provide the result of the mortality, and 2 studies were removed because they didn't provide full-text article. Finally, 15 studies were included in the systematic review 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 . The selected studies are presented in Figure 1 .…”

“…The characteristics of the selected studies are summarized in Table 3 , which indicates that the included studies came from 7 different countries. Six of the studies were conducted in Italy 19 , 20 , 21 , 22 , 4 were conducted in Spain 27 , 28 , 32 , 33 , and 1 study per country was conducted in Belgium 23 , France 24 , South Korea 25 , Turkey 26 , and Japan 29 .…”

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

“…Furthermore, recent additional studies also report that treatment with ARBs and ACE-Inhs. is associated with reduced disease severity and decreased mortality rates in COVID-19 patients ( Adrish et al, 2020 ; C. Chen et al, 2020 ; R. Chen et al ; H. K. Choi et al, 2020 ; Genet et al, 2020 ; Matsuzawa et al, 2020 ; Megaly & Glogoza, 2020 ; X. Meng et al, 2020 ; Negreira-Caamaño et al, 2020 ; Palazzuoli et al, 2020 ; Yahyavi et al, 2020 ; Y. Yuan et al, 2020 ).…”

The Interplay Between the Immune System, the Renin‐Angiotensin‐Aldosterone System (RAAS), and RAAS Inhibitors May Modulate the Outcome of COVID‐19: A Systematic Review

“…Moreover, Supplementary Table S1 summarizes the reported underlying comorbidities and the P values reported by each study to determine any significant differences between the 2 groups of COVID‐19 patients who did or did not use ACEi/ARBs. Only 2 studies reported significantly higher proportions of the control patients with underlying chronic kidney disease ( P = .001) 27 or dementia ( P = .003) 41 . However, both these studies as well as 15 other studies reported that the ACEi/ARBs groups had significantly higher proportions of patients with different comorbidities.…”