Pronóstico de los pacientes hospitalizados por Covid-19 que utilizaban inhibidores de la enzima convertidora de angiotensina o antagonistas del receptor de angiotensina II

Prognósis of patients hospitalized due to Covid-19 who were taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers

Introducción: existe controversia acerca de la seguridad del uso de inhibidores de la enzima convertidora de angiotensina (iECA) o antagonistas de los receptores de angiotensina II (ARA II) en pacientes con COVID-19, debido a que la ECA-2 sirve de entrada del virus a la célula. Objetivo: evaluar la asociación del antecedente del uso de iECA o ARA II con el ingreso a UCI o la muerte intrahospitalaria. Metodología: cohorte prospectiva multicéntrica que incluyó pacientes adultos hospitalizados por coronavirus COVID-19 en tres hospitales de Bogotá, Colombia, entre abril y noviembre 2020. Se realizó un análisis univariado evaluando la asociación de los iECA y ARA II con el ingreso a UCI o la muerte intrahospitalaria. Resultados: se incluyeron 592 pacientes de los cuales 225 (38.0%) cursaban con hipertensión arterial, 108 (18.2%) diabetes y 50 (8.4%) enfermedad cardiovascular crónica, 160 (27.0%) ingresaron a UCI y 107 (18.1%) fallecieron, 32% tenía el antecedente de uso de iECA o ARA II. En el análisis univariado no se obtuvo ninguna asociación con ingreso a UCI o muerte intrahospitalaria, uso de inhibidores de la ECA OR= 1.017 (IC95% 0.887 - 1.152, p=0.800), OR=1.072 (0.952 - 1.19, p=0.968) respectivamente; uso de ARA II OR= 0.998 (IC95% 0.913-1.086, p=0.968), OR=1.045 (IC95% 0.969 - 1.122, p=0.235), respectivamente.   Conclusiones: el antecedente del uso de los iECA o ARA II no se asoció con el ingreso a UCI o la muerte intrahospitalaria en pacientes hospitalizados por COVID-19.

1. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus. J Virol. 2020;94(7) :e00127-20. doi: 10.1128/JVI.00127-20
2. Sanchis-Gomar F, Lavie CJ, Perez-Quilis C, Henry BM, Lippi G. Angiotensin-Converting Enzyme 2 and Antihypertensives (Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors) in Coronavirus Disease 2019. Mayo Clin Proc. 2020;95(6):1222-30. doi: 10.1016/j.mayocp.2020.03.026
3. Ferrario CM, Jessup J, Chappell MC, Averill DB, Brosnihan KB, Tallant EA, Diz DI, Gallagher PE. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation. 2005;111(20):2605-10. doi: 10.1161/CIRCULATIONAHA.104.510461
4. Sommerstein R. Re: Preventing a covid-19 pandemic: ACE inhibitors as a potential risk factor for fatal Covid-19. BMJ. 2020;368:m810. doi: 10.1136/bmj.m810
5. Danser AHJ, Epstein M, Batlle D. Renin-Angiotensin System Blockers and the COVID-19 Pandemic: At Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers. Hypertension. 2020;75(6):1382-5. doi: 10.1161/HYPERTENSIONAHA.120.15082
6. Wang K, Gheblawi M, Oudit GY. Angiotensin Converting Enzyme 2: A Double-Edged Sword. Circulation. 2020;142(5):426-8. doi: 10.1161/CIRCULATIONAHA.120.047049
7. de Simone G. Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers [Internet]. 2020 [citado 2 de mayo de 2021]. Disponible en: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang
8. Kirkwood M, Poko L, Napoli N. Patients taking ACE-i and ARBs who contract COVID-19 should continue treatment, unless otherwise advised by their physician [Internet]. American Heart Association. 2020 [citado 2 de mayo de 2021]. Disponible en: https://newsroom.heart.org/news/patients-taking-ace-i-and-arbs-who-contract-covid-19-should-continue-treatment-unless-otherwise-advised-by-their-physician
9. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. doi: 10.1001/jama.2020.6775
10. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. doi: 10.1136/bmj.m1985
11. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell L, Chernyak Y, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. doi: 10.1136/bmj.m1966
12. Gupta S, Hayek SS, Wang W, Chan L, Mathews KS, Melamed ML, et al. Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US. JAMA Intern Med. 2020;180(11):1436-47. doi: 10.1001/jamainternmed.2020.3596
13. Johansen ME, Yun J, Griggs JM, Jackson EA, Richardson CR. Anti-Hypertensive Medication Combinations in the United States. J Am Board Fam Med. 2020;33(1):143-6. doi: 10.3122/jabfm.2020.01.190134
14. Ibrahim SL, Jiroutek MR, Holland MA, Sutton BS. Utilization of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in patients diagnosed with diabetes: Analysis from the National Ambulatory Medical Care Survey. Prev Med Rep. 2016;3:166-70. doi: 10.1016/j.pmedr.2016.01.005
15. Teng T-HK, Tromp J, Tay WT, Anand I, Ouwerkerk W, Chopra V, et al. Prescribing patterns of evidence-based heart failure pharmacotherapy and outcomes in the ASIAN-HF registry: a cohort study. Lancet Glob Health. 2018;6(9):e1008-18. doi: 10.1016/S2214-109X(18)30306-1
16. Chaves WG, Diaztagle JJ, Sprockel JJ, Hernandez JI, Benavidez J, Henao D, et al. Factores asociados a mortalidad en pacientes con falla cardiaca descompensada. Acta Med Colomb. 2014;39(4):314-20.
17. Reynolds HR, Adhikari S, Pulgarin C, Troxel AB, Iturrate E, Johnson SB, et al. Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19. N Engl J Med. 2020;382(25):2441-8. doi: 10.1056/NEJMoa2008975
18. Mancia G, Rea F, Ludergnani M, Apolone G, Corrao G. Renin-Angiotensin-Aldosterone System Blockers and the Risk of Covid-19. N Engl J Med. 2020;382(25):2431-40. doi: 10.1056/NEJMoa2006923
19. López-Otero D, López-Pais J, Cacho-Antonio CE, Antúnez-Muiños PJ, González-Ferrero T, Pérez-Poza M, et al. Impacto de los inhibidores de la enzima de conversión de la angiotensina y los antagonistas del receptor de la angiotensina II en la COVID-19 en una población occidental. Registro CARDIOVID. Rev Esp Cardiol. 2021;74(2):175-82. doi: 10.1016/j.recesp.2020.05.030
20. ElAbd R, AlTarrah D, AlYouha S, Bastaki H, Almazeedi S, Al-Haddad M, et al. Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARB) Are Protective Against ICU Admission and Mortality for Patients With COVID-19 Disease. Front Med (Lausanne). 2021;8:600385. doi: 10.3389/fmed.2021.600385.
21. Zhang P, Zhu L, Cai J, Lei F, Qin J-J, Xie J, et al. Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19. Circ Res. 2020;126(12):1671-81. doi: 10.1161/CIRCRESAHA.120.317134
22. Fosbøl EL, Butt JH, Østergaard L, Andersson C, Selmer C, Kragholm K, et al. Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With COVID-19 Diagnosis and Mortality. JAMA. 2020;324(2):168-177. doi: 10.1001/jama.2020.11301
23. Lee T, Cau A, Cheng MP, Levin A, Lee TC, Vinh DC, et al. Angiotensin receptor blockers and angiotensin converting enzyme inhibitors in COVID-19 -meta-analysis/meta-regression adjusted for confounding factors. CJC Open. doi: 10.1016/j.cjco.2021.03.001