COVID-19 In-Hospital Mortality and Use of Renin-Angiotensin System Blockers in Geriatrics Patients |
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| Affiliation: | 1. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Broca, Service de gériatrie, F-75013, Paris, France;2. EA 4468, Université de Paris, F-75013, Paris, France;3. Centre Hospitalier Sainte-Anne, GHU Paris Psychiatrie & Neurosciences, F-75014, Paris, France;4. Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Service de gériatrie, F-94804, Villejuif, France;5. Université Paris-Sud XI, F-94270, Le Kremlin-Bicêtre, France;6. Fondation de recherche sur l''hypertension artérielle (FRHTA), F-75013, Paris, France;7. Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Sorbonne Université, F-75013, Paris, France |
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| Abstract: | ObjectiveThe role of treatment with renin-angiotensin-aldosterone system blockers at the onset of COVID-19 infection is not known in the geriatric population. The aim of this study was to assess the relationship between angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitor (ACEI) use and in-hospital mortality in geriatric patients hospitalized for COVID-19.DesignThis observational retrospective study was conducted in a French geriatric department. Patients were included between March 17 and April 18, 2020.Setting and ParticipantsAll consecutive 201 patients hospitalized for COVID-19 (confirmed by reverse-transcriptase polymerase chain reaction methods) were included. All nondeceased patients had 30 days of follow-up and no patient was lost to follow-up.MethodsDemographic, clinical, and biological data and medications were collected. In-hospital mortality of patients treated or not by ACEI/ARB was analyzed using multivariate Cox models.ResultsMean age of the population was 86.3 (8.0) years, 62.7% of patients were institutionalized, 88.6% had dementia, and 53.5% had severe disability (activities of daily living [ADL] score <2). Sixty-three patients were treated with ACEI/ARB and 138 were not. Mean follow-up was 23.4 (10.0) days, 66 (33.8%) patients died after an average of 10.0 days (6.0). Lower mortality rate was observed in patients treated with ACEI/ARB compared with patients not treated with ARB or ACEI (22.2% [14] vs 37.7% [52], hazard ratio [HR] 0.54; 95% confidence interval 0.30–0.97; P = .03). In a multivariate Cox regression model including age, sex, ADL score, Charlson index, renal function, dyspnea, C-reactive protein, and white blood cell count, use of ACEI/ARB was significantly associated with lower in-hospital mortality (HR 0.52 (0.27−0.99), P = .048).Conclusion and ImplicationsIn very old subjects hospitalized in geriatric settings for COVID-19, mortality was significantly lower in subjects treated with ARB or ACEI before the onset of infection. The continuation of ACEI/ARB therapy should be encouraged during periods of coronavirus outbreak in older subjects. |
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| Keywords: | COVID-19 in-hospital mortality geriatrics renin-angiotensin-aldosterone system blockers angiotensin receptor blockers angiotensin-converting enzyme inhibitor |
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