scholarly journals Effect of Renin-Angiotensin-Aldosterone System Inhibitors on Short-Term Mortality After Sepsis

Hypertension ◽  
2020 ◽  
Vol 75 (2) ◽  
pp. 483-491 ◽  
Author(s):  
Wan-Ting Hsu ◽  
Brandon Patrick Galm ◽  
Gregory Schrank ◽  
Tzu-Chun Hsu ◽  
Shih-Hao Lee ◽  
...  
Keyword(s):  
Propensity Score ◽  
Meta Analysis ◽  
Hazard Ratio ◽  
Short Term ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Mortality Hazard ◽  
Short Term Mortality ◽  
Raas Inhibitors ◽  
Mortality Hazard Ratio

Antagonists of the renin-angiotensin-aldosterone system (RAAS), including ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers), may prevent organ failure. We, therefore, investigated whether specific RAAS inhibitors are associated with reduced mortality in patients with sepsis.We conducted a population-based retrospective cohort study using multivariable propensity score–based regression to control for differences among patients using different RAAS inhibitors. A multivariable-adjusted Cox proportional-hazards regression model was used to determine the association between RAAS inhibitors and sepsis outcomes. To directly compare ACEI users, ARB users, and nonusers, a 3-way propensity score matching approach was performed. Results were pooled with previous evidence via a random-effects meta-analysis. A total of 52 727 patients were hospitalized with sepsis, of whom 7642 were prescribed an ACEI and 4237 were prescribed an ARB. Using propensity score–matched analyses, prior ACEI use was associated with decreased 30-day mortality (hazard ratio, 0.84 [95% CI, 0.75–0.94]) and 90-day mortality (hazard ratio, 0.83 [95% CI, 0.75–0.92]) compared with nonuse. Prior ARB use was associated with an improved 90-day survival (hazard ratio, 0.88 [95% CI, 0.83–0.94]). These results persisted in sensitivity analyses focusing on patients without cancer and patients with hypertension. By contrast, no beneficial effect was found for antecedent β-blockers exposure (hazard ratio, 0.99 [95% CI, 0.94–1.05]). The pooled estimates obtained from the meta-analysis was 0.71 (95% CI, 0.58–0.87) for prior use of ACEI/ARB.The short-term mortality after sepsis was substantially lower among those who were already established on RAAS inhibitor treatment when sepsis occurred.

scholarly journals Comparison of renin–angiotensin–aldosterone system inhibitors with other antihypertensives in association with coronavirus disease-19 clinical outcomes: systematic review and meta-analysis

2020 ◽  
Author(s):  
Yihienew M. Bezabih ◽  
Alemayehu Bezabih ◽  
Endalkachew Aalamneh ◽  
Gregory M. Peterson ◽  
Woldesellassie M. Bezabhe
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Conclusive Evidence ◽  
Antihypertensive Drug Therapy ◽  
Severe Illness ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Raas Inhibitors

AbstractIntroductionThe effects of renin–angiotensin–aldosterone system (RAAS) inhibitors on the clinical outcomes of coronavirus disease-19 (COVID-19) have been conflicting in different studies. This meta-analysis was undertaken to provide more conclusive evidence.MethodsA systematic search for published articles was performed in PubMed and EMBASE from January 5 2020 till May 5 2020. Studies that reported the clinical outcomes of patients with COVID-19, stratified by the class of concomitant antihypertensive drug therapy, were included. The Mantel-Haenszel random effects model was used to estimate pooled odds ratio (OR).ResultsA total of 6,997 patients with COVID-19 were included, and all of them had hypertension. The overall risk of poor patient outcomes (severe COVID-19 or death) was lower in patients taking RAAS inhibitors (OR=0.84, 95% CI: [0.73, 0.96]; P=0.017) compared with those receiving non-RAAS inhibitor antihypertensives. Patients taking angiotensin-I-converting enzyme inhibitors (ACEIs) were less likely to experience poor clinical outcomes (OR=0.73, 95% CI: [0.58-0.92]; P=0.01) compared with those receiving angiotensin-II receptor blockers (ARBs). In addition, comparison of ACEIs to the rest of non-ACEI antihypertensives gave a consistently decreased risk of poor COVID-19 outcome (OR=0.77, 95% CI: [0.63-0.93]; P=0.002). However, ARBs did not decrease the risk of poor COVID-19 outcomes compared to all other non-ARB antihypertensives (OR=1.13, 95% CI: [0.95-1.35]).ConclusionThe risk of developing severe illness or death from COVID-19 was lower in patients who received RAAS inhibitors compared with those who took non-RAAS inhibitors. ACEIs might be better in decreasing the severity and mortality of COVID-19 than ARBs.

scholarly journals Comparison of renin–angiotensin–aldosterone system inhibitors with other antihypertensives in association with coronavirus disease-19 clinical outcomes

2020 ◽  
Author(s):  
Yihienew Mequanint Bezabih ◽  
Alemayehu Bezabih ◽  
Endalkachew Alamneh ◽  
Gregory M. Peterson ◽  
Woldesellassie Bezabhe
Keyword(s):  
Clinical Outcomes ◽  
Fixed Effects ◽  
Antihypertensive Drugs ◽  
Meta Analysis ◽  
Channel Blockers ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Raas Inhibitors

Abstract Background: Reports on the effects of renin–angiotensin–aldosterone system (RAAS) inhibitors on the clinical outcomes of coronavirus disease-19 (COVID-19) have been conflicting. We performed this meta-analysis to find conclusive evidence. Methods: We searched published articles through PubMed, EMBASE and medRxiv from 5 January 2020 to 3 August 2020. Studies that reported clinical outcomes of patients with COVID-19, stratified by the class of antihypertensives, were included. Random and fixed-effects models were used to estimate pooled odds ratio (OR). Results: A total 36 studies involving 30,795 patients with COVID-19 were included. The overall risk of poor patient outcomes (severe COVID-19 or death) was lower in patients taking RAAS inhibitors (OR=0.79, 95% CI: [0.67, 0.95]) compared with those receiving non-RAAS inhibitor antihypertensives. However, further sub-meta-analysis showed that specific RAAS inhibitors did not show a reduction of poor COVID-19 outcomes when compared with any class of antihypertensive except beta-blockers (BBs). For example, compared to calcium channel blockers (CCBs), neither angiotensin-I-converting enzyme inhibitors (ACEIs) (OR=0.91, 95% CI: [0.67, 1.23]) nor angiotensin-II receptor blockers (ARBs) (OR=0.90, 95% CI: [0.62, 1.33]) showed a reduction of poor COVID-19 outcomes. When compared with BBs, however, both ACEIs (OR=0.85, 95% CI: [0.73, 0.99) and ARBs (OR=0.72, 95% CI: [0.55, 0.94]) showed an apparent decrease in poor COVID-19 outcomes. Conclusions: RAAS inhibitors did not increase the risk of mortality or severity of COVID-19. Differences in COVID-19 clinical outcomes between different class of antihypertensive drugs were likely due to the underlying comorbidities for which the antihypertensive drugs were prescribed.

scholarly journals Effect of Renin-Angiotensin-Aldosterone System inhibitors on outcomes of COVID-19 patients with hypertension: Systematic review and Meta-analysis

2020 ◽  
Author(s):  
Tamirat Bekele Beressa ◽  
Tamiru Sahilu ◽  
Serawit Deyno
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Random Effects Model ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Central Register ◽  
Raas Inhibitors

Objective: This research aimed to systematically review and summarize the influence of Renin-Angiotensin-Aldosterone System (RAAS) inhibitors on the outcome of COVID_19 patients with hypertension. Methods: Electronic databases; PubMed/Medline, CINAHL, the Cochrane Central Register of Controlled Trials, clinical trial.gov, and Google Scholar were searched from 2019 to June 1, 2020. Additionally, the references of identified articles were also searched. Results: A total of 9 articles comprising 3,823 patients were incorporated; 1416 patients on RAAS inhibitors and 3469 on non-RAAS inhibitors. The study demonstrated that the taking of RAAS inhibitors in COVID_19 patients with hypertension significantly reduced mortality where patients on RAAS inhibitors had a 27% decrease of mortality (RR= 0.73 [95% CI: 0.63- 0.85, p<0.0001, I2=0%, random-effects model]) compared to those not taking ACEI/ARB. No significant association were observed in disease severity (RR= 0.92 (95% CI: 0.74- 1.14) and hospitalization (WMD= -2.33[95% CI: -5.60, 0.75]), random-effects model. Conclusion: This study supports RAAS inhibitors safe use among COVID_19 patients with hypertension. Keywords: COVID_19, ACEI, ARB, Hypertension, Coronavirus

scholarly journals Comparison of renin–angiotensin–aldosterone system inhibitors with other antihypertensives in association with coronavirus disease-19 clinical outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yihienew M. Bezabih ◽  
Alemayehu Bezabih ◽  
Endalkachew Alamneh ◽  
Gregory M. Peterson ◽  
Woldesellassie Bezabhe
Keyword(s):  
Clinical Outcomes ◽  
Fixed Effects ◽  
Antihypertensive Drugs ◽  
Meta Analysis ◽  
Channel Blockers ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Raas Inhibitors

Abstract Background Reports on the effects of renin–angiotensin–aldosterone system (RAAS) inhibitors on the clinical outcomes of coronavirus disease-19 (COVID-19) have been conflicting. We performed this meta-analysis to find conclusive evidence. Methods We searched published articles through PubMed, EMBASE and medRxiv from 5 January 2020 to 3 August 2020. Studies that reported clinical outcomes of patients with COVID-19, stratified by the class of antihypertensives, were included. Random and fixed-effects models were used to estimate pooled odds ratio (OR). Results A total 36 studies involving 30,795 patients with COVID-19 were included. The overall risk of poor patient outcomes (severe COVID-19 or death) was lower in patients taking RAAS inhibitors (OR = 0.79, 95% CI: [0.67, 0.95]) compared with those receiving non-RAAS inhibitor antihypertensives. However, further sub-meta-analysis showed that specific RAAS inhibitors did not show a reduction of poor COVID-19 outcomes when compared with any class of antihypertensive except beta-blockers (BBs). For example, compared to calcium channel blockers (CCBs), neither angiotensin-I-converting enzyme inhibitors (ACEIs) (OR = 0.91, 95% CI: [0.67, 1.23]) nor angiotensin-II receptor blockers (ARBs) (OR = 0.90, 95% CI: [0.62, 1.33]) showed a reduction of poor COVID-19 outcomes. When compared with BBs, however, both ACEIs (OR = 0.85, 95% CI: [0.73, 0.99) and ARBs (OR = 0.72, 95% CI: [0.55, 0.94]) showed an apparent decrease in poor COVID-19 outcomes. Conclusions RAAS inhibitors did not increase the risk of mortality or severity of COVID-19. Differences in COVID-19 clinical outcomes between different class of antihypertensive drugs were likely due to the underlying comorbidities for which the antihypertensive drugs were prescribed, although adverse effects of drugs such as BBs could not be excluded.

scholarly journals Convalescent Plasma and Improved Survival in Patients with Hematologic Malignancies and COVID-19

2021 ◽  
Author(s):  
Michael A. Thompson ◽  
Jeffrey P. Henderson ◽  
Pankil K. Shah ◽  
Samuel M. Rubinstein ◽  
Michael J. Joyner ◽  
...  
Keyword(s):  
Propensity Score ◽  
Plasma Treatment ◽  
Propensity Score Matching ◽  
Survival Benefit ◽  
Hematologic Malignancy ◽  
Hematologic Malignancies ◽  
Hazard Ratio ◽  
Confounding Factors ◽  
Mortality Hazard ◽  
Mortality Hazard Ratio

SummaryConvalescent plasma may benefit immunocompromised individuals with COVID-19, including those with hematologic malignancy. We evaluated the association of convalescent plasma treatment with 30-day mortality in hospitalized adults with hematologic malignancy and COVID-19 from a multi-institutional cohort. 143 treated patients were compared to 823 untreated controls. After adjustment for potential confounding factors, convalescent plasma treatment was associated with improved 30-day mortality (hazard ratio, 0.60; 95% CI, 0.37-0.97). This association remained significant after propensity-score matching (hazard ratio, 0.52; 95% CI, 0.29-0.92). These findings suggest a potential survival benefit in the administration of convalescent plasma to patients with hematologic malignancy and COVID-19.

scholarly journals META-ANALYSIS OF SAFETY AND EFFICACY OF RENIN ANGIOTENSIN ALDOSTERONE SYSTEM INHIBITORS IN COVID-19 POPULATION

2021 ◽  
Vol 77 (18) ◽  
pp. 3158
Author(s):  
Yasar Sattar ◽  
Pradeeksha Mukuntharaj ◽  
Hassan Attique ◽  
Waqas Ullah ◽  
Muhammad Khawar Sana ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Renin Angiotensin Aldosterone System ◽  
Safety And Efficacy ◽  
Renin Angiotensin

The short-term prognostic value of serum platelet to hemoglobin in patients with type A acute aortic dissection

Perfusion ◽  
2020 ◽  
pp. 026765912098222
Author(s):  
Yu Wang ◽  
Tengfei Qiao ◽  
Jun Zhou
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Acute Aortic Dissection ◽  
Independent Predictor ◽  
Type A ◽  
Short Term ◽  
Survivor Group ◽  
Mortality Hazard ◽  
Mortality Hazard Ratio ◽  
The Ideal

Purpose: Type A acute aortic dissection (AAD) is an uncommon catastrophic cardiovascular disease with high pre-hospital mortality rate without timely and effectively treated. The aim of this study was to assess the value of serum platelet to hemoglobin (PHR) in predicting in-hospital mortality in type A AAD patients. Methods: A total of 183 type A AAD patients were included in this retrospective investigation from January 2017 to December 2019. Admission blood routine parameters were gathered and PHR was computed. The outcome was all-cause in-hospital mortality within 30 days. Results The average levels of serum PHR were significant higher in survivor group than those in non-survivor group (1.14 ± 0.57 vs 0.87 ± 0.47, p = 0.006) and serum PHR was an independent factor associated with in-hospital mortality (hazard ratio (HR): 2.831; 95% confidence interval (CI): 1.108–7.231; p = 0.030). ROC noted that 0.8723 was chosen as the ideal cutoff value with a sensitivity of 64.3% and specificity of 72.5%. In addition, the area under the ROC curve (AUC) was 0.693 (95% CI 0.599–0.787, p < 0.001). Conclusion: Admission serum PHR can be used as an independent predictor of in-hospital mortality in patients with type A AAD.

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