SARS-CoV-2 infection and adverse outcomes in users of ACE inhibitors and angiotensin-receptor blockers: a nationwide case-control and cohort analysis

Christiansen, Christian Fynbo; Pottegård, Anton; Heide-Jørgensen, Uffe; Bodilsen, Jacob; Søgaard, Ole Schmeltz; Mæng, Michael; Vistisen, Simon Tilma; Schmidt, Morten; Lund, Lars Christian; Reilev, Mette; Hallas, Jesper; Voldstedlund, Marianne; Husby, Anders; Thomsen, Marianne Kragh; Johansen, Nanna Borup; Brun, Nikolai C.; Thomsen, Reimar W.; Bøtker, Hans Erik; Sørensen, Henrik Toft

doi:10.1136/thoraxjnl-2020-215768

Cited by 21 publications

(21 citation statements)

References 33 publications

(38 reference statements)

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“…In addition, the epidemiological characteristics of COVID-19 are dynamic and rapidly change within and between countries as the pandemic evolves, and large health care registries may assist in quickly testing scientific hypothesis in different settings. [11][12][13][14][15] However, registrybased analyses using diagnosis codes require that the codes are of high quality and, thus far, the validity of ICD-10 codes for COVID-19 remains unclear. This study aimed to examine the PPV of the ICD-10 diagnosis codes for COVID-19 at departments of infectious diseases in Denmark.…”

Section: Introductionmentioning

confidence: 99%

Positive Predictive Value of ICD-10 Diagnosis Codes for COVID-19

Bodilsen¹,

Leth²,

Nielsen³

et al. 2021

CLEP

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Purpose: To examine the positive predictive value (PPV) of International Classification version 10 (ICD-10) diagnosis codes for Coronavirus disease 2019 . Patients and Methods: Medical record review of all patients assigned a diagnosis code of COVID-19 (DB342A or DB972A) at six Danish departments of infectious diseases from February 27 through May 4, 2020. Confirmed COVID-19 diagnosis was defined as either: 1) definite, a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) on a respiratory sample combined with symptoms suggestive of COVID-19: 2) probable, clinical presentation of COVID-19 without detection of SARS-CoV-2 and no alternative diagnoses considered more likely; or 3) possible, clinical presentation of COVID-19 without detection of SARS-CoV-2, and the patient was discharged or deceased before further investigations were carried out. We computed the PPV with 95% confidence intervals (CI) as the number of patients with confirmed (i.e., definite, probable, and possible) COVID-19 divided by the number of patients assigned a diagnosis code for COVID-19. Results:The study included 710 patients with a median age of 61 years (interquartile range [IQR] 47-74) and 285/710 (40%) were female. COVID-19 was confirmed in 706/710 (99%) with 705/710 (99%) categorized as definite, 1/710 (0.1%) as probable, and 0 patients as possible COVID-19. The diagnosis was disproven in 4/710 (0.6%) patients who were hospitalized due to bacterial pneumonia (n = 2), influenza (n = 1), and urinary tract infection (n = 1). The overall PPV for COVID-19 was 99% (95% CI 99-100) and remained consistently high among all subgroups including sex, age groups, calendar period, and stratified by diagnosis code and department of infectious diseases (range 97-100%). Conclusion:The overall PPV of diagnosis codes for COVID-19 in Denmark was high and may be suitable for future registry-based prognosis studies of COVID-19.

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Section: Introductionmentioning

confidence: 99%

Positive Predictive Value of ICD-10 Diagnosis Codes for COVID-19

Bodilsen¹,

Leth²,

Nielsen³

et al. 2021

CLEP

Self Cite

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“…Hippisley-Cox et al [20] reported a reduced incidence of COVID-19 infection in those on ACEI/ARB overall but suggested that ARB were signifi- cantly less protective in the Black population than the Caucasian group; ACEI appeared less protective in the Caribbean than the Caucasian group and were associated with an increased risk of COVID-19 disease in the Black population; but neither medication was associated with an increased risk of receiving ICU care in their study. An et al [21] suggested that treatment with ACEI/ARB was not associated with an increased risk for COVID-19 infection, while Morales et al [22] and Christiansen et al [23] discussed that use was neither associated with higher risk nor with any adverse outcomes in patients with CO-VID-19 infection. Lopes et al [24], in their multicenter randomized trial called BRACE CORONA, aimed to evaluate whether discontinuing compared with maintaining chronic ACEI/ARB treatment among hospitalized COVID-19 patients increases days alive and out of the hospital and found no significant differences in outcomes suggesting suspending these medications was not beneficial in anyway.…”

Section: Comparison With Other Studies and Review Of The Literaturementioning

confidence: 99%

“…But, due to the importance of ACEI and ARB in routine clinical practice, articles have been published elaborating on the hypothesis of severe COVID-19 infection in those exposed to these medications [11][12][13][14][15], and several studies have been conducted to assess the true association. None of these have shown an increased risk of mortality or ICU admission in relation to ACEI/ARB [16][17][18][19][20][21][22][23][24][25][26][27][28]. Moreover, some favorable outcomes have been reported in a subset of these studies [20,[26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Hospitalized COVID-19 Patients Receiving Renin Angiotensin System Blockers and Calcium Channel Blockers

et al. 2021

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Introduction: Use of certain antihypertensive medications has been an area of interest during the COVID-19 pandemic, and several hypotheses have been developed regarding the effects of renin-angiotensin system blockers as well as calcium channel blockers in those infected with COVID-19. We seek to determine the association between exposure to ACEI, ARB, and CCB and outcomes in those admitted to the hospital with COVID-19 infection. Methods: This retrospective cohort study included 841 adult patients hospitalized with COVID-19 infection at the University of Chicago Medical Center between March 25 and June 22, 2020. Out of these 841, 453 patients had a personal history of hypertension. For the first part, we evaluated primary outcomes of in-hospital mortality and ICU admission in hospitalized COVID-19 patients based on their exposure to particular medications regardless of a personal history of hypertension and compared them with those who were not on these medications. For the second part, we evaluated the aforementioned outcomes in 453 patients with a personal history of hypertension based on their medication exposure. Secondary outcomes of length of stay, readmission rate, and new-onset dialysis requirement were also compared across the study groups. Results: Out of 841 patients, 111 (13.19%) were on ACEI/ARB (median age: 66.1, SD 15.4; 52.25% females) and 730 (86.80%) were not on them (median age: 56.6, SD 20.3; 50.14% females), while 277 (32.93%) used CCB (median age: 64.6, SD 15.2; 57.04% females) and 564 (67.06%) did not use CCB (median age: 54.6, SD 21.2; 47.16% females). After adjusting for demographics and covariates, neither ACEI/ARB nor CCB exposure was associated with any effect on mortality, but ACEI/ARB exposure was associated with 42% reduction in risk of ICU admissions (OR 0.58, 95% CI [0.35, 0.95], p value 0.03). In addition, combined use of ACEI/ARB and CCB was associated with statistically significant (45%) reduction in ICU admission (OR 0.55, 95% CI [0.32, 0.94], p value 0.029). Out of 453 patients with a personal history of hypertension, 85 (18.76%) were taking ACEI/ARB (median age 65, SD 15.6; 56.47% females) and 368 (81.24%) were not on ACEI/ARB (median age 62.8, SD 16.4; 54.89% females), while 208 (45.92%) out of 453 were on CCB (median age 65; SD 14.8; 60.1% females) and 245 (54.08%) were not on CCB (median age 61.7, SD 17.3; 51.02% females). In the fully adjusted model in this group, ACEI use was associated with 71% reduction in in-house mortality (OR 0.29, 95% CI [0.09, 0.93], p value 0.03). Discussion/Conclusion: Among all hospitalized patients with COVID-19 infection, exposure to ACEI/ARB, as well as combined exposure to ACEI/ARB and CCB, were associated with reduced incidence of ICU admissions. In those admitted patients who had a personal history of hypertension, there was a trend towards reduced in-hospital mortality in those exposed to ACEI.

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“…At the same time, infl ammation of the lung tissue, which is a distinctive characteristic of the disease and determines the originality and severity of its course, is considered as a sign, and not its basis. Various disorders that appear only from the moment of the development of the focus of infl ammation are subjected to attempts to neutralize them as the consequences of infection [43][44][45].…”

mentioning

confidence: 99%

Psychoanalysis of the doctrine of acute pneumonia

Klepikov¹

2021

Arch Pulmonol Respir Care

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SARS-CoV-2 infection and adverse outcomes in users of ACE inhibitors and angiotensin-receptor blockers: a nationwide case-control and cohort analysis

Cited by 21 publications

References 33 publications

Positive Predictive Value of ICD-10 Diagnosis Codes for COVID-19

Positive Predictive Value of ICD-10 Diagnosis Codes for COVID-19

Outcomes of Hospitalized COVID-19 Patients Receiving Renin Angiotensin System Blockers and Calcium Channel Blockers

Psychoanalysis of the doctrine of acute pneumonia

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