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Severity of COVID-19 infection in ACEI/ARB users in specialty hospitals: A retrospective cohort study

Alrashed AA 1 , Khan TM 2 , Alhusseini NK 3 , Asdaq SMB 4 , Enani M 5 , Alosaimi B 6 Show all authors , Alkhani NM 1 , Mohzari Y 7 , Alghalbi MM 8 , Alfahad W 8 , Alanazi MA 9 , Albujaidya AS 9 , Ben-Akresh A 8 , Almutairi M 10 , Abraham I 11 , Alamer A 12

Affiliations 

  • 1 Pharmaceutical Service Department, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
  • 2 The Institute of Pharmaceutical Science (IPS) of University of Veterinary and Animal Sciences, Lahore, Pakistan; School of Pharmacy, Monash University, Sunway City, Selangor, Malaysia
  • 3 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
  • 4 Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713, Riyadh, Saudi Arabia. Electronic address: sasdag@mcst.edu.sa
  • 5 Infectious Disease Section, Medical Specialties Department, King Fahad Medical City, Saudi Arabia
  • 6 Research Center, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
  • 7 Pharmacy Department, Clinical Pharmacy Section, King Saud Medical City, Saudi Arabia
  • 8 Pharmacy Services Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
  • 9 Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
  • 10 Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713, Riyadh, Saudi Arabia
  • 11 Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA; Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, Arizona, USA
  • 12 Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, Arizona, USA; Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
J Infect Public Health, 2021 Jun;14(6):726-733.
PMID: 34020213 DOI: 10.1016/j.jiph.2021.03.004

Abstract

BACKGROUND: The uncertainty about COVID-19 outcomes in angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) users continues with contradictory findings. This study aimed to determine the effect of ACEI/ARB use in patients with severe COVID-19.

METHODS: This retrospective cohort study was done in two Saudi public specialty hospitals designated as COVID-19 referral facilities. We included 354 patients with a confirmed diagnosis of COVID-19 between April and June 2020, of which 146 were ACEI/ARB users and 208 were non-ACEI/ARB users. Controlling for confounders, we conducted multivariate logistic regression and sensitivity analyses using propensity score matching (PSM) and Inverse propensity score weighting (IPSW) for high-risk patient subsets.

RESULTS: Compared to non-ACEI/ARB users, ACEI/ARB users had an eight-fold higher risk of developing critical or severe COVID-19 (OR = 8.25, 95%CI = 3.32-20.53); a nearly 7-fold higher risk of intensive care unit (ICU) admission (OR = 6.76, 95%CI = 2.88-15.89) and a nearly 5-fold higher risk of requiring noninvasive ventilation (OR = 4.77,95%CI = 2.15-10.55). Patients with diabetes, hypertension, and/or renal disease had a five-fold higher risk of severe COVID-19 disease (OR = 5.40,95%CI = 2.0-14.54]. These results were confirmed in the PSM and IPSW analyses.

CONCLUSION: In general, but especially among patients with hypertension, diabetes, and/or renal disease, ACEI/ARB use is associated with a significantly higher risk of severe or critical COVID-19 disease, and ICU care.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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