Neha Gupta, MD, FAAP
Assistant Professor
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma
Disclosure information not submitted.
Lisa Settle, DO
Resident
University of Oklhoma Health Sciences Center, United States
Disclosure information not submitted.
Brent Brown, MD
Professor, Pulmonology/ Critical care
University of Oklahoma Health & Sciences Center, United States
Disclosure information not submitted.
Vikas Bansal, MPH, MBBS
Research Fellow
Mayo Clinic
Rochester, Minnesota
Disclosure information not submitted.
Vishakha Kumar, MD, MBA
Society of Critical Care Medicine
Mount Prospect, Illinois
Disclosure information not submitted.
Rahul Kashyap, MD, MBA,
Medical Director Research
Wellspan Health-York Hospital
York, Pennsylvania
Disclosure information not submitted.
Allan Walkey, MD (he/him/his)
Professor of Medicine
Boston University
Boston, Massachusetts, United States
Disclosure information not submitted.
Christopher Aston, PhD
Biostatistician
University of Oklahoma Health Sciences Center, United States
Disclosure information not submitted.
Title: Effect of RAAS inhibitors on outcomes of hospitalized patients with SARS CoV-2 infection
Introduction: The aim of our study was to determine the effect of prior use of renin-angiotensin-aldosterone system (RAAS) inhibitors on mortality and outcomes in hospitalized patients with laboratory-confirmed SARS-CoV-2 infection.
Methods: This is an observation study of adult hospitalized patients with SARS-CoV-2 infection admitted from March 31st, 2020-March 10th, 2021, entered in the multicenter, international VIRUS COVID-19 registry.Demographic, clinical and outcome data were extracted for patients who met the inclusion criteria. Data was stratified and compared in two groups: Patients on RAAS inhibitors and those who were not on these medications. Multivariable logistic regression was performed to evaluate the effect of RAAS inhibitors on mortality during hospitalization. Secondary analysis was performed to compare outcomes among patients on only angiotensin converting enzyme inhibitors (ACEIs), only angiotensin receptor blockers (ARBs) and both ACEIs and ARBs.
Results: 26,652 patients were included in the study. Out of these, 4,210 patients were on RAAS inhibitors prior to hospitalization. Patients on RAAS inhibitors were significantly older and were Black/African American (p< 0.0001). Patients on RAAS inhibitors were more likely to be admitted to ICU directly on admission than those not on these medications (30% vs 19.7%, p< 0.0001). Comorbidities likely hypertension, diabetes, asthma, obesity, chronic kidney disease and congestive heart failure were significantly higher in RAAS inhibitor group (p< 0.0001) while no difference was seen in chronic pulmonary disease (not asthma) in both the groups (p=0.14). Patients in RAAS inhibitors group had 40% higher odds of mortality than group not on medications (p< 0.0001). Use of dialysis, mechanical ventilation and rates of complications during hospitalization were significantly higher in RAAS inhibitors group (p< 0.0001). On multivariable regression, RAAS inhibitors maintained an independent significant increased risk of mortality (OR=1.11). No difference was observed in mortality and rate of complications when comparing outcomes for patients on only ACEIs, only ARBs and both ACEIs and ARBs.
Conclusions: Patients on RAAS inhibitors prior to hospitalization for SARS-CoV-2 infection had higher mortality and complications than those not on these medications.