Impacto dos bloqueadores do receptor de angiotensina e inibidores da enzima conversora de angiotensina nos desfechos clínicos e acometimento pulmonar avaliado por inteligência artificial em pacientes hospitalizados com covid-19.

Abstract

COVID-19, caused by SARS-CoV-2, has spread around the world since 2019. In severe cases, COVID-19 can lead to hospitalization and death. Systemic arterial hypertension and other comorbidities are associated with serious clinical outcomes. Current literature is unclear whether antihypertensive therapy with angiotensin receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors are risk factors for worse outcomes in COVID-19. This is a retrospective study analyzing newly admitted patients diagnosed with COVID-19 by RT-PCR at the Hospital Geral de Fortaleza, Brazil, during 2021. Patient data were analyzed according to 3 groups: hypertensive users of ACEI/ARB, hypertensive users of other classes of antihypertensive drugs and non-hypertensive patients. Sociodemographic and clinical data were collected, and chest CT images were analyzed using CAD4COVID-CT/ThironaTM software. A total of 294 patients took part in the study. A ROC curve was created, and a cut-off point of 66% of pulmonary involvement was found, with patients having a higher risk of death and intubation, with a lower 60-day survival. Advanced age (RR 1.025 [95% CI 1.010 – 1.039] P=0.001) and intubation (RR 16.747 [95% CI 8.447 – 33.202] P<0.001) were significantly associated with a higher risk of death. Advanced age (RR 1.023 [95% CI 1.010 – 1.037] P=0.001) and the use of noninvasive ventilation (RR 1.548 [95% CI 1.028 – 2.332] P=0.037) were associated with a higher risk of intubation. Lung involvement (>66%) increased the risk of death by almost 2.5-fold (RR 2.439 [95% CI 1.601 – 3.715] P<0.001) and by more than 2.3- fold the risk of intubation (RR 2.317 [ 95% CI 1.522 - 3.527] P<0.001). The use of ACEI/ARB was not associated with a higher percentage of lung involvement related to COVID-19, nor with an increased risk of death or intubation in hypertensive patients. Our findings corroborate the updated literature that older age is a risk factor for worse COVID-19 outcomes and that ACEI or ARB medication does not affect the risk of death and disease course during hospitalization. More studies are needed to better understand the role of ACEI/ARB therapy in lung injury and COVID-19 outcomes in hospital admission and involvement of biomarkers of hyperinflammation.