Mortality, Severity, and Hospital Admission Among COVID-19 Patients with ACEI/ARB Use: A Meta-analysis Stratifying Countries Based on Response to the First Wave of the Pandemic
Abstract BackgroundThe use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) is controversial for treating COVID-19 patients. We aimed to estimate pooled risks of mortality, disease severity, and hospitalization associated with ACEI/ARB use and stratify them by country and country clusters. MethodsWe conducted a search in various databases through 7/4/2020 and then applied random-effects models to estimate pooled risks (ORp) across stratifications by country cluster. Clusters were chosen to reflect outbreak times (China followed by Korea/Italy, others subsequently) and mobility restrictions (China and Denmark/France/Spain with stricter lockdowns than the UK/US). ResultsOverall analysis showed no increase in mortality; however, a statistical increase in mortality was seen in the US/UK cluster with ORp=1.28[95%CI=1.04; 1.56] and a decrease in China with ORp=0.65[95%CI=0.43; 0.96] and France with OR=0.31[95%CI=0.14; 0.69]. Severity and hospitalization were not statistically significant in the analysis; however, several associations were seen in specific countries but not in country clusters. ConclusionThe country-cluster meta-analysis provided a reasonable explanation for COVID-19 mortality among ACEI/ARB users. The analysis did not explain differences in severity and suggested the involvement of other factors. Hospitalization findings may be considered informative as they may have been subjected to clinical decisions and hospital-bed availability.