Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19

Neha Gupta; Lisa Settle; Brent R. Brown; Donna L. Armaignac; Michael Baram; Nicholas E. Perkins; Margit Kaufman; Roman R. Melamed; Amy B. Christie; Valerie C. Danesh; Joshua L. Denson; Sreekanth R. Cheruku; Karen Boman; Vikas Bansal; Vishakha K. Kumar; Allan J. Walkey; Juan P. Domecq; Rahul Kashyap; Christopher E. Aston; Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group

doi:10.1097/CCM.0000000000005627

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Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19

Journal article

Open access

Peer reviewed

Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19

Neha Gupta, Lisa Settle, Brent R. Brown, Donna L. Armaignac, Michael Baram, Nicholas E. Perkins, Margit Kaufman, Roman R. Melamed, Amy B. Christie, Valerie C. Danesh, …

Critical care medicine, Vol.50(10), pp.e744-e758

07/27/2022

DOI: 10.1097/CCM.0000000000005627

PMCID: PMC9469914

PMID: 35894609

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Abstract

OBJECTIVES: To determine the association of prior use of renin-angiotensin-aldosterone system inhibitors (RAASIs) with mortality and outcomes in hospitalized patients with COVID-19. DESIGN: Retrospective observational study. SETTING: Multicenter, international COVID-19 registry. Subjects: Adult hospitalized COVID-19 patients on antihypertensive agents (AHAs) prior to admission, admitted from March 31, 2020, to March 10, 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were compared between three groups: patients on RAASIs only, other AHAs only, and those on both medications. Multivariable logistic and linear regressions were performed after controlling for prehospitalization characteristics to estimate the effect of RAASIs on mortality and other outcomes during hospitalization. Of 26,652 patients, 7,975 patients were on AHAs prior to hospitalization. Of these, 1,542 patients (19.3%) were on RAASIs only, 3,765 patients (47.2%) were on other AHAs only, and 2,668 (33.5%) patients were on both medications. Compared with those taking other AHAs only, patients on RAASIs only were younger (mean age 63.3 vs 66.9 yr; p < 0.0001), more often male (58.2% vs 52.4%; p = 0.0001) and more often White (55.1% vs 47.2%; p < 0.0001). After adjusting for age, gender, race, location, and comorbidities, patients on combination of RAASIs and other AHAs had higher in-hospital mortality than those on RAASIs only (odds ratio [OR] = 1.28; 95% CI [1.19–1.38]; p < 0.0001) and higher mortality than those on other AHAs only (OR = 1.09; 95% CI [1.03–1.15]; p = 0.0017). Patients on RAASIs only had lower mortality than those on other AHAs only (OR = 0.87; 95% CI [0.81–0.94]; p = 0.0003). Patients on ACEIs only had higher mortality compared with those on ARBs only (OR = 1.37; 95% CI [1.20–1.56]; p < 0.0001). CONCLUSIONS: Among patients hospitalized for COVID-19 who were taking AHAs, prior use of a combination of RAASIs and other AHAs was associated with higher in-hospital mortality than the use of RAASIs alone. When compared with ARBs, ACEIs were associated with significantly higher mortality in hospitalized COVID-19 patients.

antihypertensive agents

COVID-19

mortality

Online Clinical Investigation

outcome

renin-angiotensin-aldosterone system inhibitors

Details

Title: Subtitle: Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19
Creators: Neha Gupta - University of Oklahoma
Lisa Settle - University of Oklahoma
Brent R. Brown - University of Oklahoma
Donna L. Armaignac - Baptist Health South Florida
Michael Baram - Thomas Jefferson University
Nicholas E. Perkins - Prisma Health
Margit Kaufman - Departments of Anesthesiology and Critical Care Medicine, Englewood Health, Englewood, NJ
Roman R. Melamed - Abbott Northwestern Hospital
Amy B. Christie - Department of Critical Care, Atrium Health Navicent, Macon, GA
Valerie C. Danesh - Baylor Scott & White Health
Joshua L. Denson - Tulane University
Sreekanth R. Cheruku - Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
Karen Boman - Society of Critical Care Medicine
Vikas Bansal - Mayo Clinic in Arizona
Vishakha K. Kumar - Society of Critical Care Medicine
Allan J. Walkey - Boston University School of Medicine
Juan P. Domecq - Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
Rahul Kashyap - Mayo Clinic in Arizona
Christopher E. Aston - University of Oklahoma Health Sciences Center
Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group
Contributors: Patrick W McGonagill (Contributor) - University of Iowa, Surgery
Resource Type: Journal article
Publication Details: Critical care medicine, Vol.50(10), pp.e744-e758
DOI: 10.1097/CCM.0000000000005627
PMID: 35894609
PMCID: PMC9469914
NLM abbreviation: Crit Care Med
ISSN: 0090-3493
eISSN: 1530-0293
Publisher: Lippincott Williams & Wilkins
Language: English
Date published: 07/27/2022
Academic Unit: Surgery
Record Identifier: 9984322791402771

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