Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens
This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs). All adults with SARS-CoV-2 infection in two Italian...
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| Veröffentlicht in: | PloS one 2020-06, Vol.15 (6), p.e0235248 |
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| creator | Bravi, Francesca Flacco, Maria Elena Carradori, Tiziano Volta, Carlo Alberto Cosenza, Giuseppe De Togni, Aldo Acuti Martellucci, Cecilia Parruti, Giustino Mantovani, Lorenzo Manzoli, Lamberto |
| description | This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs).
All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50-1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40-2.23), diabetes (AOR: 1.52; 1.05-2.18), CVD (AOR: 1.88; 1.32-2.70) and COPD (AOR: 1.88; 1.11-3.20). Only gender, age and diabetes also predicted very severe/lethal disease.
No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians. |
| doi_str_mv | 10.1371/journal.pone.0235248 |
| format | Article |
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All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50-1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40-2.23), diabetes (AOR: 1.52; 1.05-2.18), CVD (AOR: 1.88; 1.32-2.70) and COPD (AOR: 1.88; 1.11-3.20). Only gender, age and diabetes also predicted very severe/lethal disease.
No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0235248</identifier><identifier>PMID: 32579597</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; Angiotensin ; Angiotensin converting enzyme inhibitors ; Angiotensin II ; Angiotensin II receptor blockers ; Angiotensin Receptor Antagonists - adverse effects ; Angiotensin Receptor Antagonists - therapeutic use ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Antihypertensive Agents - therapeutic use ; Betacoronavirus - physiology ; Biology and life sciences ; Cardiovascular disease ; Cardiovascular diseases ; Case-Control Studies ; Chronic obstructive pulmonary disease ; Converting ; Coronavirus Infections - complications ; Coronavirus Infections - drug therapy ; Coronavirus Infections - epidemiology ; Coronaviruses ; COVID-19 ; Diabetes ; Diabetes mellitus ; Disease transmission ; Drug therapy ; Electronic health records ; Electronic medical records ; Enzyme inhibitors ; Enzymes ; Female ; Guidelines as Topic ; Health services ; Hospitals ; Humans ; Hypertension ; Hypertension - drug therapy ; Infections ; Inhibitors ; Intensive care ; Italy - epidemiology ; Kidney diseases ; Laboratories ; Male ; Males ; Medicine and health sciences ; Middle Aged ; Mortality ; Multivariate analysis ; Pandemics ; Patients ; Peptidyl-dipeptidase A ; Physicians ; Pneumonia, Viral - complications ; Pneumonia, Viral - drug therapy ; Pneumonia, Viral - epidemiology ; Pre-existing conditions ; Prognosis ; Public health ; Receptors ; Retrospective Studies ; SARS-CoV-2 ; Severe acute respiratory syndrome coronavirus 2 ; Severity of Illness Index ; Signs and symptoms ; Statistics ; Viral diseases</subject><ispartof>PloS one, 2020-06, Vol.15 (6), p.e0235248</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Bravi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Bravi et al 2020 Bravi et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-65f2a7acdc6987c6bede4a4a1f2e73866eebaaed76143fea19dfa0270fd1a1a83</citedby><cites>FETCH-LOGICAL-c758t-65f2a7acdc6987c6bede4a4a1f2e73866eebaaed76143fea19dfa0270fd1a1a83</cites><orcidid>0000-0002-8129-9344 ; 0000-0002-4308-2144</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314008/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314008/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32579597$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Shimosawa, Tatsuo</contributor><creatorcontrib>Bravi, Francesca</creatorcontrib><creatorcontrib>Flacco, Maria Elena</creatorcontrib><creatorcontrib>Carradori, Tiziano</creatorcontrib><creatorcontrib>Volta, Carlo Alberto</creatorcontrib><creatorcontrib>Cosenza, Giuseppe</creatorcontrib><creatorcontrib>De Togni, Aldo</creatorcontrib><creatorcontrib>Acuti Martellucci, Cecilia</creatorcontrib><creatorcontrib>Parruti, Giustino</creatorcontrib><creatorcontrib>Mantovani, Lorenzo</creatorcontrib><creatorcontrib>Manzoli, Lamberto</creatorcontrib><title>Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs).
All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50-1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40-2.23), diabetes (AOR: 1.52; 1.05-2.18), CVD (AOR: 1.88; 1.32-2.70) and COPD (AOR: 1.88; 1.11-3.20). Only gender, age and diabetes also predicted very severe/lethal disease.
No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians.</description><subject>Age</subject><subject>Angiotensin</subject><subject>Angiotensin converting enzyme inhibitors</subject><subject>Angiotensin II</subject><subject>Angiotensin II receptor blockers</subject><subject>Angiotensin Receptor Antagonists - adverse effects</subject><subject>Angiotensin Receptor Antagonists - therapeutic use</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Betacoronavirus - physiology</subject><subject>Biology and life sciences</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Case-Control Studies</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Converting</subject><subject>Coronavirus Infections - complications</subject><subject>Coronavirus Infections - drug therapy</subject><subject>Coronavirus Infections - epidemiology</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Disease transmission</subject><subject>Drug therapy</subject><subject>Electronic health records</subject><subject>Electronic medical records</subject><subject>Enzyme inhibitors</subject><subject>Enzymes</subject><subject>Female</subject><subject>Guidelines as Topic</subject><subject>Health services</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - drug therapy</subject><subject>Infections</subject><subject>Inhibitors</subject><subject>Intensive care</subject><subject>Italy - epidemiology</subject><subject>Kidney diseases</subject><subject>Laboratories</subject><subject>Male</subject><subject>Males</subject><subject>Medicine and health sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Peptidyl-dipeptidase A</subject><subject>Physicians</subject><subject>Pneumonia, Viral - 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adverse effects</topic><topic>Angiotensin Receptor Antagonists - therapeutic use</topic><topic>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Betacoronavirus - physiology</topic><topic>Biology and life sciences</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Case-Control Studies</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Converting</topic><topic>Coronavirus Infections - complications</topic><topic>Coronavirus Infections - drug therapy</topic><topic>Coronavirus Infections - epidemiology</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Disease transmission</topic><topic>Drug therapy</topic><topic>Electronic health records</topic><topic>Electronic medical records</topic><topic>Enzyme inhibitors</topic><topic>Enzymes</topic><topic>Female</topic><topic>Guidelines as Topic</topic><topic>Health services</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - drug therapy</topic><topic>Infections</topic><topic>Inhibitors</topic><topic>Intensive care</topic><topic>Italy - epidemiology</topic><topic>Kidney diseases</topic><topic>Laboratories</topic><topic>Male</topic><topic>Males</topic><topic>Medicine and health sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Peptidyl-dipeptidase A</topic><topic>Physicians</topic><topic>Pneumonia, Viral - complications</topic><topic>Pneumonia, Viral - drug therapy</topic><topic>Pneumonia, Viral - epidemiology</topic><topic>Pre-existing conditions</topic><topic>Prognosis</topic><topic>Public health</topic><topic>Receptors</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Severity of Illness Index</topic><topic>Signs and symptoms</topic><topic>Statistics</topic><topic>Viral diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bravi, Francesca</creatorcontrib><creatorcontrib>Flacco, Maria Elena</creatorcontrib><creatorcontrib>Carradori, Tiziano</creatorcontrib><creatorcontrib>Volta, Carlo Alberto</creatorcontrib><creatorcontrib>Cosenza, Giuseppe</creatorcontrib><creatorcontrib>De Togni, Aldo</creatorcontrib><creatorcontrib>Acuti Martellucci, Cecilia</creatorcontrib><creatorcontrib>Parruti, Giustino</creatorcontrib><creatorcontrib>Mantovani, Lorenzo</creatorcontrib><creatorcontrib>Manzoli, Lamberto</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bravi, Francesca</au><au>Flacco, Maria Elena</au><au>Carradori, Tiziano</au><au>Volta, Carlo Alberto</au><au>Cosenza, Giuseppe</au><au>De Togni, Aldo</au><au>Acuti Martellucci, Cecilia</au><au>Parruti, Giustino</au><au>Mantovani, Lorenzo</au><au>Manzoli, Lamberto</au><au>Shimosawa, Tatsuo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-06-24</date><risdate>2020</risdate><volume>15</volume><issue>6</issue><spage>e0235248</spage><pages>e0235248-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs).
All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50-1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40-2.23), diabetes (AOR: 1.52; 1.05-2.18), CVD (AOR: 1.88; 1.32-2.70) and COPD (AOR: 1.88; 1.11-3.20). Only gender, age and diabetes also predicted very severe/lethal disease.
No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32579597</pmid><doi>10.1371/journal.pone.0235248</doi><tpages>e0235248</tpages><orcidid>https://orcid.org/0000-0002-8129-9344</orcidid><orcidid>https://orcid.org/0000-0002-4308-2144</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-06, Vol.15 (6), p.e0235248 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2416999057 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Age Angiotensin Angiotensin converting enzyme inhibitors Angiotensin II Angiotensin II receptor blockers Angiotensin Receptor Antagonists - adverse effects Angiotensin Receptor Antagonists - therapeutic use Angiotensin-Converting Enzyme Inhibitors - therapeutic use Antihypertensive Agents - therapeutic use Betacoronavirus - physiology Biology and life sciences Cardiovascular disease Cardiovascular diseases Case-Control Studies Chronic obstructive pulmonary disease Converting Coronavirus Infections - complications Coronavirus Infections - drug therapy Coronavirus Infections - epidemiology Coronaviruses COVID-19 Diabetes Diabetes mellitus Disease transmission Drug therapy Electronic health records Electronic medical records Enzyme inhibitors Enzymes Female Guidelines as Topic Health services Hospitals Humans Hypertension Hypertension - drug therapy Infections Inhibitors Intensive care Italy - epidemiology Kidney diseases Laboratories Male Males Medicine and health sciences Middle Aged Mortality Multivariate analysis Pandemics Patients Peptidyl-dipeptidase A Physicians Pneumonia, Viral - complications Pneumonia, Viral - drug therapy Pneumonia, Viral - epidemiology Pre-existing conditions Prognosis Public health Receptors Retrospective Studies SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Severity of Illness Index Signs and symptoms Statistics Viral diseases |
| title | Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens |
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