Role of Angiotensin-converting Enzyme Inhibitors (ACEI)/Angiotensin Receptor Blockers (ARBs) and Hydrocortisone in COVID-19 Patients Admitted to the Intensive Care Unit

Abstract

Objective: The purpose of study was to assess the role of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) and hydrocortisone in patients with COVID-19 and their outcome during hospitalization.
 Materials and Methods: A clinical comparative prospective hospital-based study was conducted in the Department of Pulmonology & Intensive Care Unit (ICU) of Dow University of Medical & Health Sciences, Karachi in patients positive for COVID-19 infection during their hospitalization. A comparative analysis was performed between two groups, i) those who received an injection of hydrocortisone and ii) those who received oral ACEi/ARB. All the baselines and clinical variables were recorded in a structured questionnaire and the data were evaluated in the Statistical Package for the Social Sciences (SPSS) version 22.0. A p-value of <0.05 is considered statistically significant.
 Results: The final analysis was performed on 130 patients among them 68 patients received an injection of hydrocortisone and 62 patients received the tablet ACEi/ARB, which ever indicated. Patients who need injection hydrocortisone were older than patients who received ACEi/ARB, 58.37±15.20 and 51.01±90.22. Patients who received injection hydrocortisone were more likely to receive mechanical ventilation support as compared to other groups, 11.7% vs. 4.8%, respectively, p-value 0.02. The overall mortality rate was 10% (n = 13) in both groups in which a higher number of deaths was observed in patients who were taking ACEi/ARB as compared to patients who were receiving injection hydrocortisone, 12.9% vs. 7.3%, respectively, but it had an insignificant association, p-value 0.17.
 Conclusion: We have observed in our study that patients who received an injection of hydrocortisone had lower rates of mortality irrespective of their gender and age while patients who received ACEi/ARB during hospitalization had lower complications rate but higher mortality rates.