RAAS inhibitors are associated with better COVID-19 prognosis

Objectives:
Some studies of hospitalized patients suggested that the risk of death and/or severe illness due to COVID-19 is not associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin II receptor type 1 blockers (ARBs). Nevertheless, some controversy still exists and there is limited information of the ACEIs/ARBs effect size on COVID-19 prognosis. Therefore, this review article has been conducted.

Are RAAS inhibitors associated with better COVID-19 prognosis?

Study design:
This review article included 16 studies with a total of 24,676 COVID-19 patients, comparing patients with critical (n = 4134) vs. non-critical (n = 20,542) outcomes.

All 16 studies included adult patients of both sexes, mean/median estimated age ranging from 50 to >70 years

The Begg and Mazumdar's rank correlation test (Kendall`s tau -0.23, p = 0.11) shows no publication bias.

Results and conclusions:   
The investigators found, effect estimate showed an overall protective effect of RAAS inhibitors/blockers (ACEIs, ARBs, and/or ACEIs/ARBs) with 23.2% reduced risk of death and/or critical disease [OR = 0.768, 95% CI = 0.651 to 0.907, p = 0.0018].
The removal of one study at a time (sensitivity analysis) showed robust estimation of the pooled effect [estimated ORs from 0.744, 95% CI = 0.633 to 0.874 to 0.813, 95% CI = 0.699 to 0.946, p = 0.0003 to 0.0075].

The investigators found the use of ACEIs (OR = 0.652, 95% CI = 0.478 to 0.891, p = 0.0072] but not ACEIs/ARBs [OR = 0.867, 95% CI = 0.638 to 1.179, p = NS] or ARBs alone [OR = 0.810, 95% CI = 0.629 to 1.044, p = NS] showed a significant 34.8% reduction in the risk of death/critical disease and explained the overall protection displayed by RAAS inhibition combined.

The investigators concluded Renin-Angiotensin-Aldosterone-System (RAAS) inhibitors, especially the use of ACEIs are associated with better COVID-19 prognosis.

Original title:
Estimation of RAAS-Inhibitor Effect on the COVID-19 Outcome: A Meta-analysis by Pirola  CJ and Silvia Sookoian S.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255761/

Additional information of El Mondo:
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