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Abstract: PO0845

RAAS Inhibition, Mortality, and Severity in COVID-19 Patients: A Systematic Review and Meta-Analysis

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Ali, Hatem, University Hospitals of Birmingham, Birmingham, UK, Birmingham, Birmingham, United Kingdom
  • Mohamed, Mahmoud Magdy, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Daoud, Ahmed, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
  • Fulop, Tibor, Medical University of South Carolina, Charleston, South Carolina, United States
  • Posadas, Maria Aurora C., Medical University of South Carolina, Charleston, South Carolina, United States
  • Casey, Michael, Medical University of South Carolina, Charleston, South Carolina, United States
  • Rao, Vinaya, Medical University of South Carolina, Charleston, South Carolina, United States
  • Soliman, Karim Magdy, Medical University of South Carolina, Charleston, South Carolina, United States
Background

The effect of angiotensin-receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEi) on outcome and severity in COVID-19 patients has been postulated.

Methods

We performed a systematic review in different databases to identify studies and research work that assessed the association of ACEi/ARBs on the severity of illness and mortality in COVID-19 subjects. Inclusion criteria for our meta-analysis were all studies that included human subjects with COVID-19 infection, reported mortality and severity of the disease, and described ACEi/ARB treatment. The data collected were the name of the first author, journal title, the country of the study, sample size, relative risk and confidence intervals for association of ACEi/ARB treatment and mortality and severity. We used the random-effects model for the meta-analysis and the funnel plot analysis to assess potential publication bias.

Results

Out of 4,702 records reviewed in different databases, 11 papers were included in our meta-analysis. Altogether, 8,643 patients were included in the final analysis. Random effects model (REM) for the relationship between ACEi/ARB and survival showed that ACEi/ARB does not affect survival (relative risk [RR]=0.81, confidence interval ranges [CIR] from 0.53 to 1.23). There was no evidence of heterogeneity with I-squared =25.5% and p<0.235. By applying Egger’s test, there was no evidence of small studies effect with P=0.64. REM for the relationship between ACEi/ARB and disease severity showed that ACEi/ARB are not related to disease severity (RR=0.90, CIR from 0.70 to 1.15). There was evidence of heterogeneity with I-squared =56.2% and p=0.01. By applying Egger’s test, there was no evidence of small studies effect with P=0.93.

Conclusion

Based on the results of this meta-analysis, ACEi/ARB are not associated with increased mortality or severity in COVID-19 subjects.