Clinical Features of COVID-19 in Patients With Essential Hypertension and the Impacts of Renin-angiotensin-aldosterone System Inhibitors on the Prognosis of COVID-19 Patients

Hypertension is one of the most common comorbidities in patients with coronavirus disease 2019 (COVID-19). This study aimed to clarify the impact of hypertension on COVID-19 and investigate whether the prior use of renin-angiotensin-aldosterone system (RAAS) inhibitors affects the prognosis of COVID-19. A total of 996 patients with COVID-19 were enrolled, including 282 patients with hypertension and 714 patients without hypertension. Propensity score-matched analysis (1:1 matching) was used to adjust the imbalanced baseline variables between the 2 groups. Patients with hypertension were further divided into the RAAS inhibitor group (n=41) and non-RAAS inhibitor group (n=241) according to their medication history. The results showed that COVID-19 patients with hypertension had more severe secondary infections, cardiac and renal dysfunction, and depletion of CD8 + cells on admission. Patients with hypertension were more likely to have comorbidities and complications and were more likely to be classified as critically ill than those without hypertension. Cox regression analysis revealed that hypertension (hazard ratio, 95% CI, unmatched cohort [1.80, 1.20–2.70]; matched cohort [2.24, 1.36–3.70]) was independently associated with all-cause mortality in patients with COVID-19. In addition, hypertensive patients with a history of RAAS inhibitor treatment had lower levels of C-reactive protein and higher levels of CD4 + cells. The mortality of patients in the RAAS inhibitor group (9.8% versus 26.1%) was significantly lower than that of patients in the non-RAAS inhibitor group. In conclusion, hypertension may be an independent risk factor for all-cause mortality in patients with COVID-19. Patients who previously used RAAS inhibitors may have a better prognosis.

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C-reactive protein to albumin ratio provides important long-term prognostic information in patients undergoing endovascular abdominal aortic repair

Vascular ◽

10.1177/17085381211062736 ◽

2022 ◽

pp. 170853812110627

Author(s):

Gökhan Demirci ◽

Ali Riza Demir ◽

Begüm Uygur ◽

Umit Bulut ◽

Yalcin Avci ◽

...

Keyword(s):

Cox Regression ◽

Endovascular Aneurysm Repair ◽

C Reactive Protein ◽

Albumin Ratio ◽

Cox Regression Analysis ◽

Reactive Protein ◽

Abdominal Aortic ◽

All Cause Mortality ◽

The Impact

Background The prognostic value of C-reactive protein/albumin ratio (CAR) is of import in cardiovascular diseases. Our aim was to evaluate the impact of the CAR in patients with asymptomatic abdominal aortic aneurysm (AAA) undergoing endovascular aneurysm repair (EVAR). Material and Method We retrospectively evaluated 127 consecutive patients who underwent technically successful elective EVAR procedure between December 2014 and September 2020. The optimal CAR cut-off value was determined by using receiver operating characteristic (ROC) curve analysis. Based on the cut-off value, we investigated the association of CAR with long-term all-cause mortality. Results 32 (25.1%) of the patients experienced all-cause mortality during a mean 32.7 ± 21.7 months’ follow-up. In the group with mortality, CAR was significantly higher than in the survivor group (4.63 (2.60–11.88) versus 1.63 (0.72–3.24), p < 0.001). Kaplan–Meier curves showed a higher incidence of all-cause mortality in patients with high CAR compared to patients with low CAR (log-rank test, p < 0.001). Multivariable Cox regression analysis revealed that glucose ≥ 110 mg/dL (HR: 2.740; 95% CI: 1.354–5.542; p = 0.005), creatinine ≥ 0.99 mg/dL (HR: 2.957, 95% CI: 1.282–6.819, p = 0.011) and CAR > 2.05 (HR: 8.190, 95% CI: 1.899–35.320, p = 0.005) were the independent predictors of mortality. Conclusion CAR was associated with a significant increase in postoperative long-term mortality in patients who underwent EVAR. Preoperatively calculated CAR can be used as an important prognostic factor.

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Impact of Renin-Angiotensin-Aldosterone-System Inhibitor Drugs on Mortality in Patients with Atrial Fibrillation and Hypertension

10.21203/rs.3.rs-1188151/v1 ◽

2021 ◽

Author(s):

Wei Xu ◽

Yan-Min Yang ◽

Jun Zhu ◽

Shuang Wu ◽

Juan Wang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cox Regression ◽

Angiotensin Receptor Blockers ◽

Cardiovascular Death ◽

Renin Angiotensin Aldosterone System ◽

Cox Regression Analysis ◽

Renin Angiotensin ◽

The Impact ◽

Reduced Risk

Abstract Background Renin-angiotensin-aldosterone-system inhibitors markedly played an active role in the primary and secondary prevention of atrial fibrillation (AF), but the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on the mortality of patients with AF remains unclear. This study aimed to examine the relationship between treatment with ACEIs or ARBs and the mortality in emergency department (ED) patients with AF and hypertension. Methods This multicenter study enrolled 2016 ED patients from September 2008 to April 2011; Total 1110 patients with AF and hypertension were analyzed. Patients were grouped according to whether they were treated with ACEI/ARB or not and completed a 1-year follow-up to evaluate outcomes including all-cause death, cardiovascular death, stroke, and major adverse events (MAEs). Results Among the 1110 patients with AF and hypertension, 574 (51.7%) received ACEI/ARB treatment. During the 1-year follow-up, 169 all-cause deaths (15.2%) and 100 cardiovascular deaths (9.0%) occurred, while 98 strokes (8.8%) and 255 MAEs (23.0%) occurred. According to the multivariate Cox regression analysis, ACEI/ARB therapy was significantly associated with a reduced risk of all-cause death (HR, 0.642; 95% CI, 0.466–0.884; P = 0.007). Moreover, ACEI/ARB therapy was independently associated with a reduced risk of cardiovascular death (HR, 0.649; 95% CI, 0.424–0.993; P = 0.046) and MAEs (HR: 0.701, 95% CI 0.541–0.907, P = 0.007) after adjusting for other risk factors. Conclusions Our results revealed that ACEI/ARB therapy was independently associated with a reduced risk of all-cause death, cardiovascular death, and MAEs in ED patients with AF and hypertension. These results provide evidence for a tertiary preventive treatment for patients with atrial fibrillation and hypertension.

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Impact of Early C-Reactive Protein/Albumin Ratio on Intra-Hospital Mortality Among Patients with Spontaneous Intracerebral Hemorrhage

Journal of Clinical Medicine ◽

10.3390/jcm9041236 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1236 ◽

Cited By ~ 2

Author(s):

Michael Bender ◽

Kristin Haferkorn ◽

Michaela Friedrich ◽

Eberhard Uhl ◽

Marco Stein

Keyword(s):

Regression Analysis ◽

Intracerebral Hemorrhage ◽

Hospital Mortality ◽

Cox Regression ◽

Spontaneous Intracerebral Hemorrhage ◽

C Reactive Protein ◽

Albumin Ratio ◽

Cox Regression Analysis ◽

Reactive Protein ◽

The Impact

Objective: The impact of increased C-reactive protein (CRP)/albumin ratio on intra-hospital mortality has been investigated among patients admitted to general intensive care units (ICU). However, it was not investigated among patients with spontaneous intracerebral hemorrhage (ICH). This study aimed to investigate the impact of CRP/albumin ratio on intra-hospital mortality in patients with ICH. Patients and Methods: This retrospective study was conducted on 379 ICH patients admitted between 02/2008 and 12/2017. Blood samples were drawn upon admission and the patients’ demographic, medical, and radiological data were collected. The identification of the independent prognostic factors for intra-hospital mortality was calculated using binary logistic regression and COX regression analysis. Results: Multivariate regression analysis shows that higher CRP/albumin ratio (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.193–2.317, p = 0.003) upon admission is an independent predictor of intra-hospital mortality. Multivariate Cox regression analysis indicated that an increase of 1 in the CRP/albumin ratio was associated with a 15.3% increase in the risk of intra-hospital mortality (hazard ratio = 1.153, 95% CI = 1.005–1.322, p = 0.42). Furthermore, a CRP/albumin ratio cut-off value greater than 1.22 was associated with increased intra-hospital mortality (Youden’s Index = 0.19, sensitivity = 28.8, specificity = 89.9, p = 0.007). Conclusions: A CRP/albumin ratio greater than 1.22 upon admission was significantly associated with intra-hospital mortality in the ICH patients.

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RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS AND COVID-19 COMPLICATIONS

10.51162/health2021-0001 ◽

2021 ◽

Author(s):

ARTHUR FIOROTTO DE MATTOS ◽

NATHALIA SILVEIRA BARSOTTI ◽

RAFAEL RIBEIRO ALMEIDA

Keyword(s):

Rna Virus ◽

Host Cells ◽

Converting Enzyme ◽

Respiratory Complications ◽

Renin Angiotensin Aldosterone System ◽

Renin Angiotensin ◽

The World ◽

Raas Inhibitors ◽

The Impact ◽

Different Tissues

The world faces today a pandemic of unquestionable importance, caused by an infection with a new enveloped RNA virus that belongs to the Coronaviridae family. The new coronavirus (SARS-CoV 2) uses a glycoprotein present on its surface to bind to and infect host cells that express the angiotensin converting enzyme II (ACE-2). Although different tissues may be targeted by the virus, respiratory complications remain as the main cause of death. It has been demonstrated that Renin-Angiotensin-Aldosterone System (RAAS) inhibitors increase ACE-2 expression in animal models, raising the concern that patients under treatment with these drugs could become more susceptible to COVID-19 complications. Here, we discuss the impact of RAAS inhibitors on COVID-19 outcomes and show that no evidence so far supports that the use of these drugs could pose a risk to SARS-CoV 2-infected patients. In fact, clinical data suggest that RAAS inhibitors may even act in a protective way against COVID-19 complications and should not be discontinued.,

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Increasing prescription of renin–angiotensin–aldosterone system blockers associated with improved kidney prognosis in Korean IgA nephropathy patients

Clinical Kidney Journal ◽

10.1093/ckj/sfaa204 ◽

2020 ◽

Author(s):

Sehoon Park ◽

Chung Hee Baek ◽

Su-Kil Park ◽

Hee Gyung Kang ◽

Seung Hyeok Han ◽

...

Keyword(s):

Time Trends ◽

Cox Regression ◽

Immunoglobulin A ◽

Clinicopathologic Characteristics ◽

Renin Angiotensin Aldosterone System ◽

Cox Regression Analysis ◽

Renin Angiotensin ◽

Risk Of Progression ◽

Tertiary Hospitals ◽

End Stage

Abstract Background We aimed to describe the characteristics of immunoglobulin A nephropathy (IgAN) in Korea with assessment for time trends. Methods We performed a multicenter retrospective observational cohort study including biopsy-confirmed native IgAN cases from four tertiary hospitals in Korea. Time eras of diagnosis were stratified into 1979–2003, 2004–9 and 2010–17. The prognostic variable was progression to end-stage kidney disease (ESKD) analyzed by multivariable Cox regression analysis. Results We included 1366 (from 1979 to 2003), 1636 (from 2004 to 2009) and 1442 (from 2010 to 2017) IgAN patients in this study. In the recent periods, IgAN had relatively better clinical characteristics, as patients had higher estimated glomerular filtration rates and lower baseline blood pressures than before. The use of renin–angiotensin–aldosterone system (RAAS) blockers increased from 57.7% in 1979–2003 to 80.0% in 2010–17. During a median follow-up duration of 11.3 years, 722 patients progressed to ESKD with an incidence rate of 12.5 per 1000 person-years. The 10-year risk of progression to ESKD was lower in 2010–17 compared with that of 1979–2003 [adjusted hazard ratio 0.692 (95% confidence interval 0.523–0.915)], even after adjustment for multiple clinicopathologic characteristics. The use of RAAS blockers was a significant mediator (P < 0.001) for the association between time trends and lower 10-year ESKD risk. Conclusions Clinicopathologic characteristics of IgAN in Korea have changed over time. Although the limitation of a retrospective observational study remains, the result showed that the prognosis of IgAN has improved over the study period, possibly related to increased prescription of RAAS blockers.

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The effect of renin–angiotensin–aldosterone system inhibitors on organ-specific ace2 expression in zebrafish and its implications for COVID-19

Scientific Reports ◽

10.1038/s41598-021-03244-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Gha-hyun J. Kim ◽

Adam Melgoza ◽

Fei Jiang ◽

Su Guo

Keyword(s):

Pcr Analysis ◽

Specific Information ◽

Renin Angiotensin Aldosterone System ◽

Angiotensin Converting Enzyme 2 ◽

Renin Angiotensin ◽

Organ Specific ◽

Vertebrate Model ◽

Potential Risks ◽

Raas Inhibitors ◽

The Impact

AbstractAmong cases of SARS-CoV-2 infections that result in serious conditions or death, many have pre-existing conditions such as hypertension and are on renin–angiotensin–aldosterone system (RAAS) inhibitors. The angiotensin-converting-enzyme-2 (ACE2), a key protein of the RAAS pathway, also mediates cellular entry of SARS-CoV-2. RAAS inhibitors might affect the expression levels of ace2, which could impact patient susceptibility to SARS-CoV-2. However, multi-organ-specific information is currently lacking and no species other than rodents have been examined. To address this knowledge gap, we treated adult zebrafish with the RAAS inhibitors aliskiren, olmesartan, and captopril for 7 consecutive days and performed qRT-PCR analysis of major RAAS pathway genes in the brain, gill, heart, intestine, kidney, and liver. Both olmesartan and captopril significantly increased ace2 expression in the heart, gill, and kidney. Olmesartan also increased ace2 expression in the intestine. Conversely, aliskiren significantly decreased ace2 expression in the heart. Discontinuation of compound treatments for 7 days did not return ace2 expression to baseline levels. While potential risks or benefits of antihypertensive RAAS inhibitors to SARS-CoV-2 infections in humans remain uncertain, this study provides new insights regarding the impact of RAAS inhibitors on organ-specific ace2 expression in another vertebrate model, thereby providing comparative data and laying scientific groundwork for future clinical decisions of RAAS inhibitor use in the context of COVID-19.

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CHA2DS2-VASc Score as a Predictor of Cardiovascular and All-Cause Mortality in Chronic Kidney Disease Patients

American Journal of Nephrology ◽

10.1159/000516121 ◽

2021 ◽

pp. 1-8

Author(s):

Nina Vodošek Hojs ◽

Robert Ekart ◽

Sebastjan Bevc ◽

Nejc Piko ◽

Radovan Hojs

Keyword(s):

Chronic Kidney Disease ◽

Regression Analysis ◽

Kidney Disease ◽

Cox Regression ◽

Smoking Status ◽

High Sensitivity ◽

Cox Regression Analysis ◽

Reactive Protein ◽

All Cause Mortality

Introduction: Chronic kidney disease (CKD) is a risk factor for cardiovascular and all-cause mortality. Recognition of high-risk patients is important and could lead to a different approach and better treatment. The CHA2DS2-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF), but it is also a useful predictor of outcome in other cardiovascular conditions, independent of AF. Therefore, the aim of our research was to assess the role of CHA2DS2-VASc score in predicting cardiovascular and all-cause mortality in CKD patients. Methods: Stable nondialysis CKD patients were included. At the time of inclusion, medical history data and standard blood results were collected and CHA2DS2-VASc score was calculated. Patients were followed till the same end date, until kidney transplantation or until their death. Results: Eighty-seven CKD patients were included (60.3 ± 12.8 years, 66% male). Mean follow-up time was 1,696.5 ± 564.6 days. During the follow-up, 21 patients died and 11 because of cardiovascular reasons. Univariate Cox regression analysis showed that CHA2DS2-VASc score is a significant predictor of cardiovascular and all-cause mortality. In multivariate Cox regression analysis, in which CHA2DS2-VASc score, serum creatinine, urinary albumin/creatinine, hemoglobin, high-sensitivity C-reactive protein, and intact parathyroid hormone were included, CHA2DS2-VASc score was an independent predictor of cardiovascular (HR: 2.04, CI: 1.20–3.45, p = 0.008) and all-cause mortality (HR: 2.06, CI: 1.43–2.97, p = 0.001). The same was true after adding total cholesterol, triglycerides, and smoking status to both the analyses. Conclusion: The CHA2DS2-VASc score is a simple, practical, and quick way to identify the risk for cardiovascular and all-cause mortality in CKD patients.

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Low density Lipoprotein Cholesterol and all-Cause Mortality rate Findings from a Study on Japanese Community-Dwelling Persons

10.21203/rs.3.rs-597720/v1 ◽

2021 ◽

Author(s):

Ryuichi Kawamoto ◽

Asuka Kikuchi ◽

Taichi Akase ◽

Daisuke Ninomiya ◽

Teru Kumagi

Keyword(s):

Regression Analysis ◽

Cox Regression ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

History Of

Abstract Background: Low-density lipoprotein cholesterol (LDL-C) independently impacts aging-related health outcomes and plays a critical role in cardiovascular diseases (CVDs). However, there are limited predictive data on all-cause mortality, especially for the Japanese community population. In this study, it was examined whether LDL-C is related to survival prognosis based on 7 or 10 years of follow-up.Methods: Participants included 1,610 men (63 ± 14 years old) and 2,074 women (65 ± 12 years old) who participated in the Nomura cohort study conducted in 2002 (first cohort) and 2014 (second cohort) and who continued throughout the follow-up periods (follow-up rates: 94.8% and 98.0%). Adjusted relative risk estimates were obtained for all-cause mortality using a basic resident register. The data were analyzed by a Cox regression with age as the time variable and risk factors including gender; age; body mass index (BMI); presence of diabetes; lipid levels; renal function; serum uric acid levels; blood pressure; and history of smoking, drinking, and CVD.Results: Of the 3,684 participants, 326 (8.8%) were confirmed to be deceased. Of these, 180 were men (11.2% of all men) and 146 were women (7.0% of all women). The univariate Cox regression analysis revealed that the hazard ratios (HRs) for all-cause mortality significantly increased with a decrease in LDL-C level (P < 0.001). The multivariate Cox regression analysis with adjustment variables showed that LDL-C grouping (HR: 0.71; 95% confidence interval [CI]: 0.62–0.82), gender (HR: 0.69, 95% CI: 0.51–0.93), age (HR: 1.09; 95% CI: 1.08–1.11), BMI (HR: 0.68; 95% CI: 0.54–0.86), history of CVD (HR: 1.38; 95% CI: 1.03–1.82), and presence of diabetes (HR: 1.65; 95% CI: 1.23–2.22) were significantly associated with all-cause mortality. Compared with individuals with LDL-C levels of 144 mg/dL or higher, the multivariate-adjusted HRs (95% CI) for all-cause mortality were 2.68 (1.67–4.28) for those with LDL-C levels under 70 mg/dL and 1.74 (1.17–2.59) for those with LDL-C levels between 70 and 92 mg/dL. Conclusions: There is an inverse relationship between the risk of all-cause mortality and LDL-C level, and this association is statistically significant.

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The impact of low triiodothyronine levels on mortality is mediated by malnutrition and cardiac dysfunction in incident hemodialysis patients

Acta Endocrinologica ◽

10.1530/eje-13-0540 ◽

2013 ◽

Vol 169 (4) ◽

pp. 409-419 ◽

Cited By ~ 10

Author(s):

Hyang Mo Koo ◽

Chan Ho Kim ◽

Fa Mee Doh ◽

Mi Jung Lee ◽

Eun Jin Kim ◽

...

Keyword(s):

Cardiac Dysfunction ◽

Cox Regression ◽

Survival Rates ◽

Mortality Rates ◽

Left Ventricular ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Echocardiographic Parameters ◽

Stage Renal Disease ◽

The Impact

ObjectiveLittle is known about the impact of low triiodothyronine (T3) levels on mortality in end-stage renal disease (ESRD) patients starting hemodialysis (HD) and whether this impact is mediated by malnutrition, inflammation, or cardiac dysfunction.Design and methodsA prospective cohort of 471 incident HD patients from 36 dialysis centers within the Clinical Research Center for ESRD in Korea was selected for this study. Based on the median value of T3, patients were divided into ‘higher’ and ‘lower’ groups, and all-cause and cardiovascular (CV) mortality rates were compared. In addition, associations between T3levels and various nutritional, inflammatory, and echocardiographic parameters were determined.ResultsCompared with those in the ‘higher’ T3group, albumin, cholesterol, and triglyceride levels, lean body mass estimated by creatinine kinetics (LBM-Cr), and normalized protein catabolic rate (nPCR) were significantly lower in patients with ‘lower’ T3levels. The ‘lower’ T3group also had a higher left ventricular mass index (LVMI) and a lower ejection fraction (EF). Furthermore, correlation analysis revealed significant associations between T3levels and nutritional and echocardiographic parameters. All-cause and CV mortality rates were significantly higher in patients with ‘lower’ T3levels than in the ‘higher’ T3group (113.4 vs 18.2 events per 1000 patient-years,P<0.001, and 49.8 vs 9.1 events per 1000 patient-years,P=0.001, respectively). The Kaplan–Meier analysis also showed significantly worse cumulative survival rates in the ‘lower’ T3group (P<0.001). In the Cox regression analysis, low T3was an independent predictor of all-cause mortality even after adjusting for traditional risk factors (hazard ratio=3.76,P=0.021). However, the significant impact of low T3on all-cause mortality disappeared when LBM-Cr, nPCR, LVMI, or EF were incorporated into the models.ConclusionLow T3has an impact on all-cause mortality in incident HD patients, partly via malnutrition and cardiac dysfunction.

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Effect of renin-angiotensin-aldosterone system inhibitors on Covid-19 patients in Korea

PLoS ONE ◽

10.1371/journal.pone.0248058 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248058

Author(s):

Jungchan Park ◽

Seung-Hwa Lee ◽

Seng Chan You ◽

Jinseob Kim ◽

Kwangmo Yang

Keyword(s):

Service Use ◽

Antihypertensive Drugs ◽

Data Set ◽

Renin Angiotensin Aldosterone System ◽

Renin Angiotensin ◽

Insurance Benefit ◽

Significant Difference ◽

All Cause Mortality ◽

Raas Inhibitors ◽

Ventilator Care

Background The effect of renin-angiotensin-aldosterone system (RAAS) inhibitors in coronavirus disease 19 (Covid-19) patients has not been fully investigated. We evaluated the association between RAAS inhibitor use and outcomes of Covid-19. Methods This study was a retrospective observational cohort study that used data based on insurance benefit claims sent to the Health Insurance Review and Assessment Service of Korea by May 15, 2020. These claims comprised all Covid-19 tested cases and the history of medical service use in these patients for the past five years. The primary outcome was all-cause mortality, and the rate of ventilator care was compared between the groups. Results From a total of 7,590 patients diagnosed with Covid-19, two distinct cohorts were generated based on RAAS inhibitors prescribed within 6 months before Covid-19 diagnosis. A total of 1,111 patients was prescribed RAAS inhibitors, and 794 patients were prescribed antihypertensive drugs, excluding RAAS inhibitors. In propensity-score matched analysis, 666 pairs of data set were generated, and all-cause mortality of the RAAS inhibitor group showed no significant difference compared with the non-RAAS inhibitor group (14.6% vs. 11.1%; hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.54–1.15; p = 0.22). The rate of ventilator care was not significantly different between the two groups (4.4% vs. 4.1%; HR, 1.04; 95%CI, 0.60–1.79; p = 0.89). Conclusions RAAS inhibitor treatment did not appear to increase the mortality of Covid-19 patients compared with other antihypertensive drugs, suggesting that they may be safely continued in Covid-19 patients.

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