Abstract
(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates respiratory epithelium through angiotensin-converting enzyme-2 binding, raising concerns about the potentially harmful effects of renin–angiotensin system inhibitors (RASi) on Human Coronavirus Disease 2019 (COVID-19) evolution. This study aimed to provide insight into the impact of RASi on SARS-CoV-2 outcomes in patients hospitalized for COVID-19. (2) Methods: This was a retrospective analysis of hospitalized adult patients with SARS-CoV-2 infection admitted to a university hospital in France. The observation period ended at hospital discharge. (3) Results: During the study period, 943 COVID-19 patients were admitted to our institution, of whom 772 were included in this analysis. Among them, 431 (55.8%) had previously known hypertension. The median age was 68 (56–79) years. Overall, 220 (28.5%) patients were placed under mechanical ventilation and 173 (22.4%) died. According to previous exposure to RASi, we defined two groups, namely, “RASi” (n = 282) and “RASi-free” (n = 490). Severe pneumonia (defined as leading to death and/or requiring intubation, high-flow nasal oxygen, noninvasive ventilation, and/or oxygen flow at a rate of ≥5 L/min) and death occurred more frequently in RASi-treated patients (64% versus 53% and 29% versus 19%, respectively). However, in a propensity score-matched cohort derived from the overall population, neither death (hazard ratio (HR) 0.93 (95% confidence interval (CI) 0.57–1.50), p = 0.76) nor severe pneumonia (HR 1.03 (95%CI 0.73–1.44), p = 0.85) were associated with RASi therapy. (4) Conclusion: Our study showed no correlation between previous RASi treatment and death or severe COVID-19 pneumonia after adjustment for confounders.
Highlights
Human Coronavirus Disease 2019 (COVID-19) resulting from a newly described respiratory viral infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originally started in December 2019 in Wuhan, China, and rapidly became a global pandemic, as officially recognized by the World Health Organization on the 11 March 2020
We report a retrospective analysis of adult hospitalized patients from a university hospital from the Eastern France, one of the areas in Europe most affected by the first wave of the COVID-19 pandemic
All patients aged more than 18 years old were selected on the basis of laboratory-confirmed COVID-19 infection by positive reverse-transcriptase polymerase chain reaction (RT-PCR)
Summary
Human Coronavirus Disease 2019 (COVID-19) resulting from a newly described respiratory viral infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originally started in December 2019 in Wuhan, China, and rapidly became a global pandemic, as officially recognized by the World Health Organization on the 11 March 2020. A minor proportion of infected individuals (15%) develop severe forms of infection requiring hospitalization, while 5% are critical and need intensive care support and mechanical ventilation [1]. Cardiovascular risk factors, such as hypertension, diabetes, and obesity, as well as cardiovascular disease, are associated with worse prognosis [2]. ACE2 signaling through the MAS/G-coupled protein receptor pathway possesses a cardiovascular protective function, balancing the effect of RAS activation [5]. As ACE2, which is highly expressed in the lungs, the kidneys, the gut, and the brain, plays a key role in viral cell entry, the implication of RAS and RASi in the severity of COVID-19 infection is being questioned [7]. We report a retrospective analysis of adult hospitalized patients from a university hospital from the Eastern France, one of the areas in Europe most affected by the first wave of the COVID-19 pandemic
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