Renin-Angiotensin-Aldosterone System Inhibitors and Outcome in Patients With SARS-CoV-2 Pneumonia

Abstract

A CE (angiotensin-converting enzyme) 2-an enzyme that physiologically counters the activation of the renin-angiotensin-aldosterone system (RAAS)-is the functional receptor for SARS-CoV-2-the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic.Since ACE inhibitors and angiotensin receptor blockers (ARBs) may affect ACE2 expression, 1 concerns regarding their safety in patients with COVID-19 have been raised.Aim of the present study was to describe patient characteristics, ongoing pharmacological treatment at the time of admission, and any association between chronic use of ACE inhibitors/ARBs and adverse COVID-19 clinical outcome in the first 191 consecutive patients admitted to our institution.This is a retrospective, observational study from a single tertiary center (San Raffaele Hospital, Milan) involved in frontline care during COVID-19 outbreak in Italy.We included all adult patients admitted to our hospital from February 27 to March 17, 2020, with a confirmed diagnosis of SARS-CoV-2 pneumonia by chest radiograph or computed tomographic scan and real-time polymerase chain reaction.Data were obtained from electronic medical records.Heart failure (HF) and chronic kidney disease were defined according to the European Society of Cardiology and Kidney Disease Improving Global Outcome guidelines.Multivariate analysis was performed including only covariates that were significantly associated with the risk of death at univariate analysis and the convention of limiting the number of independent variables to 1 for ≈10 events was followed.The study was approved by the local ethics committee.During the index period, 212 patients were admitted to the emergency department of our hospital and then hospitalized for SARS-CoV-2 pneumonia.Excluding patients with incomplete data collection and lost to follow-up, the final study population consisted of 191 patients (mean age,