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MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    RAAS blockers and region-specific variations in COVID-19 outcomes: findings from a systematic review and meta-analysis

    Authors: Upinder Kaur; Sankha Shubhra Chakrabarti; Tejas K Patel; Lisa Hirschhorn; Teresa Zembower; Joyce Ho; Naomi Kalume; Ojoma Agbo; Alex Zhu; Laura Rasmussen-Torvic; Sadiya Khan; Mercedes Carnethon; Mark Huffman; Charlesnika Evans

    doi:10.1101/2020.09.09.20191445 Date: 2020-09-13 Source: medRxiv

    Background: Coronavirus disease 2019 (COVID-19) has evolved as a global crisis with high mortality seen in elderly TRANS and people with cardiometabolic diseases MESHD. The use of renin angiotensin aldosterone system (RAAS) blockers in these patients is known to enhance the expression of ACE-2, the chief binding receptor of SARS-CoV-2 and may potentially enhance infectivity. Objective: To provide a pooled estimate of the effect of RAAS blocker usage on COVID-19 outcomes. Data Sources: An electronic literature search was performed for published (using MEDLINE/PubMed and Google Scholar) and preprint (using bioRxiv and medRxiv) studies of interest. The last search was conducted on 9th July 2020. Study Selection: Studies reporting data on RAAS blocker use and COVID-19 mortality and severity were included in the review. Data Extraction and Synthesis: Mortality data and severity data including hospitalization, intensive care unit (ICU) admission, invasive ventilation, steroid use and acute kidney injury HP acute kidney injury MESHD ( AKI MESHD) were recorded. Pooled Odds ratio (OR) estimates were reported with 95% CIs and level of heterogeneity (I2). Main Outcomes and Measures: Odds of mortality in users of RAAS blockers with respect to non-users was the primary outcome. Odds of severity, hospitalization, ICU admission, mechanical ventilation, steroid use, and AKI MESHD in users with respect to non-users of RAAS blockers were the secondary outcomes. Results: Of 1348 articles identified, 48 published studies were included in the final analysis, with a total of 26432 patients from 31 studies included in mortality analysis and 20127 patients from 23 studies included in severity analysis. Majority of the studies (41.6%) were from China. No increased risk of mortality (Pooled OR 0.91 (0.65-1.26), I2=89%) or severity (Pooled OR 1.08 (0.79-1.46), I2=88%) was seen with RAAS blockers. The drug class was protective in hypertension HP hypertension MESHD (pooled OR 0.63 (0.46-0.86), I2=58%). Severity of COVID-19 outcomes was found to be high for Europeans (Pooled OR 2.08 (1.52-2.85), I2=77%) and US patients (Pooled OR 1.87 (1.62-2.17) in users of RAAS-blockers. A nearly 4 times higher risk of hospitalization, two times higher risk of ICU admission and mechanical ventilation was observed in US patients on RAAS blockers. No net effect on mortality and severity outcomes was seen in Chinese patients. RAAS blocker usage did not have any effect on corticosteroid use and AKI in Chinese patients. Conclusions and Relevance: Use of RAAS blockers is not associated with increased risk of mortality in COVID-19 patients. Reduced mortality is seen in hypertensive patients with COVID-19 and therefore the drugs should be continued in this subset. US and European patients are at higher risk of severe outcomes. Pharmacogenomic differences may explain the ethnicity related variations.

    Risk Factors and Outcomes of Acute Kidney Injury HP Acute Kidney Injury MESHD in Critically Ill Patients With Coronavirus Disease MESHD 2019

    Authors: Yichun Cheng; Nanhui Zhang; Ran Luo; Meng Zhang; Zhixiang Wang; Lei Dong; Junhua Li; Rui Zeng; Ying Yao; Shuwang Ge; Gang Xu

    doi:10.21203/rs.3.rs-32532/v1 Date: 2020-05-30 Source: ResearchSquare

    Background: Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Acute kidney injury HP Acute kidney injury MESHD ( AKI MESHD) is a common complication in patients admitted to the intensive care unit. We aimed toassess the incidence, risk factors and in-hospital outcomes of AKI MESHD in COVID-19 patients admitted to intensive care unitMethods: we conducted a retrospective observational study in intensive care unit of Tongji hospital, which was assigned responsibility for the treatments of severe COVID-19 patients by Wuhan government. The AKI MESHD was defined and staged based onKidney Disease MESHD: Improving Global Outcomes (KDIGO) criteria. Mild AKI MESHD was defined as stage 1, and severe AKI MESHD was defined as stage 2 or stage 3. We used logistic regression analysis to evaluate AKI MESHD risk factors and the association between AKI MESHD and in-hospital mortality.Results: A total of 150 patients with COVID-19 were included in our study. The median age TRANS of patients was 70 (interquartile range, 60-80) years and 62.7% were male TRANS. 70 (46.7%) patients developed AKI MESHD during hospitalization, corresponding to the 17.3% in stage 1 and 9.3% in stage 2 and 20.0% in stage 3, respectively. Compared to patients without AKI MESHD, patients with AKI MESHD had higher proportion of mechanical ventilation mortality and higher in-hospital mortality. 95.5% patients with severe AKI MESHD received mechanical ventilation and in-hospital mortality was up to 79.5%. Severe AKI MESHD was independently associated with high in-hospital mortality (OR: 4.30; 95% CI: 1.83-10.10). Logistic regression analysis demonstrated that high serum SERO interleukin-6 (OR: 2.54; 95%CI: 1.00-6.42) and interleukin-10 (OR: 3.02; 95%CI: 1.17-7.82) were risk factors for severe AKI MESHD development.Conclusions: severe AKI MESHD was associated with high in-hospital mortality and inflammatory response may play a role in AKI MESHD development in critically ill MESHD patients with COVID-19. 

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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