Adverse impact of renin-angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study

Abstract We investigated the association between angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) and the risk of mortality in hospitalized severe COVID-19 patients. A retrospective cohort study was performed on all hospitalized COVID-19 patients in tertiary hospitals in Daegu, Korea. Patients were classified based on whether they received ACE-I or ARB before COVID-19 diagnosis. The Cox proportional hazards regression model was used for the analysis of survival. Of 130 COVID-19 patients, 30 (23.1%) who received ACE-I or ARB showed an increased the risk of in-hospital mortality (adjusted HR, 2.15; 95% CI, 1.04 to 4.44; P = 0.038). ACE-I or ARB were also associated with acute respiratory distress syndrome or mechanical ventilation (adjusted OR, 3.38; 95% CI, 1.18 to 9.69; P = 0.024), and acute kidney injury or shock (adjusted OR, 2.81; 95% CI, 1.04 to 7.56; P = 0.042). Among the patients with ACE-I or ARB, 14 (46.7%) discontinued the therapy and the cessation was associated with a higher mortality rate. ACE-I or ARB therapy in severe COVID-19 patients was associated with occurrence of severe complications and increased in-hospital mortality. Discontinuation of ACE-I or ARB in patients with more severe COVID-19 was not associated with improvement of mortality.