Key result
Prior use of RAAS inhibitors was not associated with a higher risk of in-hospital mortality among hospitalized COVID-19 patients (adjusted OR 0.88; 95% CI 0.53-1.44; P=.60).
Why the study?
Does prior use of RAAS inhibitors increase mortality in patients with COVID-19?
Cohort (n=5,179)
Yes
Does prior use of RAAS inhibitors increase mortality in patients with COVID-19?
Prior use of RAAS inhibitors is not independently associated with increased mortality among patients with COVID-19, supporting the continuation of these medications during the infection.
Answers are grounded in this paper and cite their sources.
Prior RAAS inhibitor use was not associated with higher COVID-19 mortality; leaves open whether continuation during infection is safe pending randomized data.
BACKGROUND: Renin-angiotensin-aldosterone system (RAAS) inhibitors may facilitate host cell entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or attenuate organ injury via RAAS blockade. We aimed to assess the associations between prior use of RAAS inhibitors and clinical outcomes among Korean patients with coronavirus disease 2019 (COVID-19). METHODS: We performed a nationwide population-based cohort study using the Korean Health Insurance Review and Assessment database. Claim records were screened for 69 793 individuals who were tested for COVID-19 until 8 April 2020. Adjusted odds ratios (ORs) were used to compare the clinical outcomes between RAAS inhibitor users and nonusers. RESULTS: Among 5179 confirmed COVID-19 cases, 762 patients were RAAS inhibitor users and 4417 patients were nonusers. Relative to nonusers, RAAS inhibitor users were more likely to be older, male, and have comorbidities. Among 1954 hospitalized patients with COVID-19, 377 patients were RAAS inhibitor users, and 1577 patients were nonusers. In-hospital mortality was observed for 33 RAAS inhibitor users (9%) and 51 nonusers (3%) (P < .001). However, after adjustment for age, sex, Charlson comorbidity index, immunosuppression, and hospital type, the use of RAAS inhibitors was not associated with a higher risk of mortality (adjusted OR, 0.88; 95% confidence interval, 0.53-1.44; P = .60). No significant differences were observed between RAAS inhibitor users and nonusers in terms of vasopressor use, modes of ventilation, extracorporeal membrane oxygenation, renal replacement therapy, and acute cardiac events. CONCLUSIONS: Our findings suggest that prior use of RAAS inhibitors was not independently associated with mortality among COVID-19 patients in Korea.
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Jung et al. (2020) conducted a cohort in COVID-19 (n=5,179). Renin-angiotensin-aldosterone system (RAAS) inhibitors vs. nonusers was evaluated on in-hospital mortality (adjusted OR 0.88, 95% CI 0.53-1.44, p=.60). Prior use of RAAS inhibitors was not associated with a higher risk of in-hospital mortality among hospitalized COVID-19 patients (adjusted OR 0.88; 95% CI 0.53-1.44; P=.60).
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