肾素-血管紧张素-醛固酮系统阻断剂对 COVID-19 患者不良预后的影响。

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiology Pub Date : 2024-07-22 DOI:10.1159/000540499

Poornima Vinod, Vinod Krishnappa, William Rathell, Godwin Dogbey, Hiten Patel, William Herzog

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引用次数: 0

摘要

导言：肾素-血管紧张素-醛固酮系统（RAAS）中的血管紧张素转换酶 2（ACE2）是导致 2019 年冠状病毒病（COVID-19）的严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）进入细胞的功能受体。SARS-CoV-2 与 ACE2 之间的相互作用是传染性的潜在致病因素。我们的研究旨在确定 RAAS 抑制剂与 COVID-19 住院患者心血管和其他不良结局的相关性：这是一项回顾性研究，研究对象为 2020 年 3 月至 2020 年 10 月期间因 COVID-19 住院的≥18 岁患者的医疗记录。主要结果为急性心血管事件（ST段抬高型心肌梗死、非ST段抬高型心肌梗死1型、急性充血性心力衰竭、急性卒中）和死亡率。次要结果为呼吸衰竭、机械通气需求和持续时间、急性深静脉血栓或肺栓塞（DVT/PE）以及再入院率：在 376 名住院的 COVID-19 患者中，有 149 人使用 RAAS 抑制剂。在急性心血管事件（6% vs. 6.2%，P=0.94）、急性深静脉血栓/肺栓塞（4.7% vs. 4.8%，P=0.94）和再入院率方面，RAAS 抑制剂组和非 RAAS 抑制剂组之间没有统计学差异。4.8%，P=0.97）、缺氧（62.4% vs. 58.6%，P=0.46）、机械通气需求（18.1% vs. 16.7%，P=0.72）、死亡率（19.5% vs. 22%，P=0.56）和再入院率（11.4% vs. 14.1%，P=0.45）。发现的一些细微差别是，接受 RAAS 抑制剂治疗的美国原住民住院率更高（30.2% vs 19.8%），接受 RAAS 抑制剂治疗的患者降钙素原水平明显更低：结论：在 COVID-19 的住院患者中，与未服用 RAAS 抑制剂的患者相比，服用 RAAS 抑制剂的患者在急性心血管事件、急性深静脉血栓/PE、缺氧、机械通气需求、再入院或死亡率方面没有明显差异。不过，还需要进一步的大规模研究来验证这些发现。

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Effect of Renin-Angiotensin-Aldosterone System Blockers on Adverse Outcomes in COVID-19 Patients.

Introduction: Angiotensin-converting enzyme 2 (ACE2) of the renin-angiotensin-aldosterone system (RAAS) serves as a functional receptor to gain entry into the cells for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). The interaction between SARS-CoV-2 and ACE2 is a potential virulent factor in infectivity. Our study aimed to ascertain the association of RAAS inhibitors with adverse cardiovascular and other outcomes in hospitalized COVID-19 patients.

Methods: This is a retrospective study of medical records of ≥18-year-old patients hospitalized for COVID-19 from March 2020 to October 2020. Primary outcomes were acute cardiovascular events (ST-elevation myocardial infarction, non-ST-elevation myocardial infarction type 1, acute congestive heart failure, acute stroke) and mortality. Secondary outcomes were respiratory failure, need for and duration of mechanical ventilation, acute deep vein thrombosis or pulmonary embolism (DVT/PE), and readmission rate.

Results: Among 376 hospitalized COVID-19 patients, 149 were on RAAS inhibitors. No statistically significant differences were found between RAAS inhibitor and non-RAAS inhibitor groups with respect to acute cardiovascular events (6% vs. 6.2%, p = 0.94), acute DVT/PE (4.7% vs. 4.8%, p = 0.97), hypoxia (62.4% vs. 58.6%, p = 0.46), need for mechanical ventilation (18.1% vs. 16.7%, p = 0.72), mortality (19.5% vs. 22%, p = 0.56), and readmission rate (11.4% vs. 14.1%, p = 0.45). Some nuances discovered were a higher rate of hospitalizations among Native Americans receiving RAAS inhibitors (30.2% vs. 19.8%) and significantly lower levels of procalcitonin in patients on RAAS inhibitors.

Conclusions: Among hospitalized patients with COVID-19, those on RAAS inhibitors showed no significant differences in acute cardiovascular events, acute DVT/PE, hypoxia, need for mechanical ventilation, readmission, or mortality rate compared to those not on them. However, further large-scale studies are needed to validate these findings.

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来源期刊

Cardiology 医学-心血管系统

CiteScore

3.40

自引率

5.30%

发文量

审稿时长

1.5 months

期刊介绍： ''Cardiology'' features first reports on original clinical, preclinical and fundamental research as well as ''Novel Insights from Clinical Experience'' and topical comprehensive reviews in selected areas of cardiovascular disease. ''Editorial Comments'' provide a critical but positive evaluation of a recent article. Papers not only describe but offer critical appraisals of new developments in non-invasive and invasive diagnostic methods and in pharmacologic, nutritional and mechanical/surgical therapies. Readers are thus kept informed of current strategies in the prevention, recognition and treatment of heart disease. Special sections in a variety of subspecialty areas reinforce the journal''s value as a complete record of recent progress for all cardiologists, internists, cardiac surgeons, clinical physiologists, pharmacologists and professionals in other areas of medicine interested in current activity in cardiovascular diseases.