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Vol. 162. Issue 4.
Pages 163-169 (February 2024)
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Vol. 162. Issue 4.
Pages 163-169 (February 2024)
Original article
Influence of angiotensin receptor and converting enzyme blockers therapy in the respiratory outcome of COVID-19 hospitalized patients
Influencia de la terapia con bloqueadores del receptor de angiotensina y de la enzima convertidora en el resultado respiratorio de pacientes hospitalizados por COVID-19
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Felipe B. Limaa,b, Francisco Wilker Mustafa Gomes Munizc, Gdayllon C. Menesesd, Karine C. Bezerraa, Carolyne N. Moreiraa, André P. Aguiara, José Carlos R. Nascimentoa,b, Tainá Veras de S. Freitasa, Pedro Felipe C. de Bruina, Eanes Delgado B. Pereiraa, Elizabeth de F. Dahera, Reinaldo B. Oriáa,
Corresponding author
oria@ufc.br

Corresponding author.
a Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
b Department of Anesthesiology, Hospital Geral de Fortaleza (HGF), Fortaleza, CE, Brazil
c Department of Periodontology, Federal University of Pelotas, Pelotas, RS, Brazil
d Clinical Medicine Department, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
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Tables (2)
Table 1. Distribution of the relative frequency for the different variables.
Table 2. Association between independent variables and the outcomes: percentage of pulmonary involvement, death considering intubation as independent variable, death not considering intubation as independent variable, and need for intubation/mechanical ventilation.
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Abstract
Objectives

COVID-19, caused by SARS-CoV-2, has spread around the world since 2019. In severe cases, COVID-19 can lead to hospitalization and death. Systemic arterial hypertension and other comorbidities are associated with serious COVID-19 infection. Literature is unclear whether antihypertensive therapy with angiotensin receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors affect COVID-19 outcomes. We aim to assess whether ACEI/ARB therapy is a risk factor for worse respiratory outcomes related to COVID-19 in hospitalized patients.

Methods

Retrospective study enrolling admitted COVID-19-diagnosed patients by RT-PCR at the Hospital Geral de Fortaleza, Brazil, during 2021. Patient medical records, sociodemographic, and clinical data were analyzed. Chest CT images were analyzed using CAD4COVID-CT/Thirona™ software.

Results

A total of 294 patients took part in the study. A cut-off point of 66% of pulmonary involvement was found by ROC curve, with patients having higher risk of death and intubation and lower 60-day survival. Advanced age (RR 1.025, P=0.001) and intubation (RR 16.747, P<0.001) were significantly associated with a higher risk of death. Advanced age (RR 1.023, P=0.001) and the use of noninvasive ventilation (RR 1.548, P=0.037) were associated with a higher risk of intubation. Lung involvement (>66%) increased the risk of death by almost 2.5-fold (RR 2.439, P<0.001) and by more than 2.3-fold the risk of intubation (RR 2.317, P<0.001).

Conclusions

Altogether, our findings suggest that ACEI or ARB therapy does not affect the risk of death and disease course during hospitalization.

Keywords:
Angiotensin-converting enzyme 2
Antihypertensive agents
Artificial intelligence
Hypertension
Lung
Renin–angiotensin system
Resumen
Objetivos

La COVID-19, causada por el SARS-CoV-2, se ha extendido por todo el mundo desde 2019. En casos graves, la COVID-19 puede provocar hospitalización y muerte. La hipertensión arterial sistémica y otras comorbilidades se asocian con una infección grave por COVID-19. La literatura no está clara si la terapia antihipertensiva con bloqueadores de los receptores de angiotensina (BRA) e inhibidores de la enzima convertidora de angiotensina (ECA) afecta los resultados de la COVID-19. Nuestro objetivo fue evaluar si la terapia BRA/ECA es un factor de riesgo de peores resultados respiratorios relacionados con COVID-19 en pacientes hospitalizados.

Métodos

Estudio retrospectivo que incluyó pacientes ingresados con diagnóstico de COVID-19 mediante RT-PCR en el Hospital General de Fortaleza, Brasil, durante 2021. Se analizaron las historias clínicas de los pacientes, datos sociodemográficos y clínicos. Las imágenes de TC de tórax se analizaron utilizando el software CAD4COVID-CT/ThironaTM.

Resultados

Participaron en el estudio un total de 294 pacientes. Mediante curva ROC se encontró un punto de corte del 66% de afectación pulmonar, teniendo los pacientes mayor riesgo de muerte e intubación y menor supervivencia a 60 días. La edad avanzada (RR 1,025; P=0,001) y la intubación (RR 16,747; P<0,001) se asociaron significativamente con un mayor riesgo de muerte. La edad avanzada (RR 1,023; P=0,001) y el uso de ventilación no invasiva (RR 1,548; P=0,037) se asociaron con un mayor riesgo de intubación. La afectación pulmonar (>66%) aumentó el riesgo de muerte casi 2,5 veces (RR 2,439; P<0,001) y más de 2,3 veces el riesgo de intubación (RR 2,317, P<0,001).

Conclusiones

Se concluyó que el tratamiento con BRA o ECA no afecta el riesgo de muerte y el curso de la enfermedad durante la hospitalización.

Palabras clave:
Enzima convertidora de angiotensina 2
Antihipertensivos
Inteligencia artificial
Hipertensión
Pulmón
Sistema renina-angiotensina

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