Patient group demographic information
The two patient groups were similar in age and sex, and most had no known pre-existing CVD, suggesting that most patients were undergoing ACEi/ARBs treatment for hypertension (Figure 1). All patients with a history of ACEi/ARBs treatment were hypertensive, compared to 38.7% patients with no ACEi/ARBs treatment. The number of diabetic patients in the ACEi/ARBs-treatment group was higher than that in the no ACEi/ARBs-treatment group (41.2% vs 19.0%, P = 0.06) (Table 1).
Effect on cardiac injury
There were no significant differences in admission cTnI levels between the two groups (median [IQR], ACEi/ARBs group, 33pg/ml [19.3-157.7], vs no ACEi/ARBs group, 52.6 pg/ml [21.63-211.8], P = 0.56). ACEi/ARBs treatment did not result in increased cardiac injury compared to no ACEi/ARBs treatment, as determined by peak cTnI, (150.5 pg/ml [31.75-1179], vs 207 pg/ml [54.65-989.4], respectively, P = 0.21). In addition, the ΔcTnI was not significantly different between the two groups (ACEi/ARBs treatment, 0 pg/ml [0-292.3] [12/17 patients with ΔcTnI = 0], vs no ACEi/ARBs treatment, 20 pg/ml [0-305.9], P=0.13) (Table 1). Moreover, evolution of cardiac injury was compared with temporal changes in cTnI, no statistically significant difference was found between any two points in the daily measurements including day 6, 9, 12, 15, 18, 21, 24, 27, 30, and 33 (Figure 2). After adjustment with age, sex and a diagnosis of hypertension, multivariate regression analysis revealed that ACEi/ARBs treatment was not associated with the peak cTnI level (P = 0.65) (Table 1).
Effect on in-hospital death, ventilatory support, and atrial arrhythmias
The mortality rate in the ACEi/ARBs treatment group was 52.9% compared to a rate of 69.9% in the no ACEi/ARBs treatment group (P = 0.17). Also, the ratio of ventilated patients was lower in the ACEi/ARBs treatment group than that in the no ACEi/ARBs treatment group (29.4% vs 48.2%, respectively, P = 0.14). Atrial arrhythmias were documented in 11.7% of the ACEi/ARBs treatment group, vs 24.4% in the no ACEi/ARBs treatment group (P = 0.36) (Table 1).
Table 1. ACEi/ARB Treatment and In-hospital Outcomes of COVID-19 Patients
|
ACEi/ARB
(n=17)
|
No ACEi/ARB
(n=137)
|
P value
|
Age, yrs
|
71 (63.5, 77)
|
69 (62, 77)
|
ns
|
Male (%)
|
7 (41.2%)
|
72 (52.6%)
|
ns
|
Hypertension (%)
|
17 (100%)
|
53 (38.7%)
|
˂0.0001
|
Diabetes (%)
|
7 (41.2%)
|
26 (19.0%)
|
ns
|
Pre-existing CVD (%)
|
5 (29.4%)
|
25 (18.3%)
|
ns
|
Admission cTnI (pg/ml)
|
33 (19.3, 157.7)
|
52.6 (21.63, 211.8)
|
ns
|
Ventilated patients (%)
|
5 (29.4%)
|
66 (48.2%)
|
ns
|
Peak Creatinine (umol/L)
|
81 (67.5, 124.5)
|
99.6 (74.25, 198)
|
ns
|
Peak cTnI (pg/ml)
|
150.5 (31.75, 1179)
|
207 (54.65, 989.4)
|
ns
|
ΔcTnI (pg/ml)
|
0 (0, 292.3)
|
20 (0, 305.9)
|
ns
|
In-hospital death (%)
|
9 (52.9%)
|
95 (69.3%)
|
ns
|
Atrial arrythmias (%)
|
2 (11.8%)
|
33 (24.1%)
|
ns
|
Multivariate Adjusted prediction of ACEi/ARB treatment for cTnI level
|
|
β(Coefficient)*
|
95%CI*
|
P value
|
ACEi/ARB treatment
|
-0.095
|
(-0.51, 0.33)
|
ns
|
CVD: cardiovascular disease; cTnI: cardiac troponin I; CI: confidence intervals.
*Adjusted by age, sex, and a diagnosis of hypertension.