COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Etiology Jung SY, Choi JC, You SH, et al. Association of Renin-angiotensin-aldosterone System Inhibitors With Coronavirus Disease 2019 (COVID-19)- Related Outcomes in Korea: A Nationwide Population-based Cohort Study. Clin Infect Dis. 2020 Nov 19;71(16):2121-2128. doi: 10.1093/cid/ciaa624.

BACKGROUND: Renin-angiotensin-aldosterone system (RAAS) inhibitors may facilitate host cell entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or attenuate organ injury via RAAS blockade. We aimed to assess the associations between prior use of RAAS inhibitors and clinical outcomes among Korean patients with coronavirus disease 2019 (COVID-19).

METHODS: We performed a nationwide population-based cohort study using the Korean Health Insurance Review and Assessment database. Claim records were screened for 69 793 individuals who were tested for COVID-19 until 8 April 2020. Adjusted odds ratios (ORs) were used to compare the clinical outcomes between RAAS inhibitor users and nonusers.

RESULTS: Among 5179 confirmed COVID-19 cases, 762 patients were RAAS inhibitor users and 4417 patients were nonusers. Relative to nonusers, RAAS inhibitor users were more likely to be older, male, and have comorbidities. Among 1954 hospitalized patients with COVID-19, 377 patients were RAAS inhibitor users, and 1577 patients were nonusers. In-hospital mortality was observed for 33 RAAS inhibitor users (9%) and 51 nonusers (3%) (P < .001). However, after adjustment for age, sex, Charlson comorbidity index, immunosuppression, and hospital type, the use of RAAS inhibitors was not associated with a higher risk of mortality (adjusted OR, 0.88; 95% confidence interval, 0.53-1.44; P = .60). No significant differences were observed between RAAS inhibitor users and nonusers in terms of vasopressor use, modes of ventilation, extracorporeal membrane oxygenation, renal replacement therapy, and acute cardiac events.

CONCLUSIONS: Our findings suggest that prior use of RAAS inhibitors was not independently associated with mortality among COVID-19 patients in Korea.

Discipline / Specialty Area Score
Infectious Disease
Intensivist/Critical Care
Hospital Doctor/Hospitalists
Internal Medicine
Comments from MORE raters

Cardiology rater

This is important information for clinical practice.

Hospital Doctor/Hospitalists rater

This study is very informative. As this was a large cohort study for the whole of the population, I regret that the authors did not show an association between RAS inhibitor use and the incidence of COVID-19. Although RAAS inhibitors was not associated with a higher mortality after adjustment for age, sex and comorbidities, the authors did not evaluate increased severity cases in RAAS inhibitor users (377 hospitalization among 762 RAAS inhibitor users, 49.5%) in comparison with RAAS inhibitor non-users (1577/4417, 35.7%). The authors should have elucidated the reason for the abrupt elevation in mortality immediately after admission in RAAS inhibitor users. It is very curious whether discontinuations of RAAS inhibitor use is associated with the unfavorable outcomes.

Internal Medicine rater

The study is reasonably well conducted, but it does not really add anything new. Most of us stopped worrying about ACE inhibitors months ago.