An umbrella review and meta-analysis of the use of renin-angiotensin system drugs and COVID-19 outcomes: what do we know so far?
Abstract Backgrounds Evidence from several meta-analyses are still controversial about the effects of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin-receptor blockers (ARBs) on COVID-19 outcomes.Purpose Umbrella review of systematic reviews/meta-analysis to provide comprehensive assessment of the effect of ACEIs/ARBs on COVID-19 related outcomes by summarising the currently available evidence.Data Source Medline (OVID), Embase, Scopus, Cochrane library and medRxiv from inception to 1stFebruary 2021.Study Selection Systematic reviews with meta-analysis that evaluated the effect of ACEIs/ARBs on COVID-19 related clinical outcomesData Extraction Two reviewers independently extracted the data and assessed studies’ risk of bias using AMSTAR 2 Critical Appraisal Tool.Data Synthesis Pooled estimates were combined using the random-effects meta-analyses model including several sub-group analyses. Overall, 47 reviews were eligible for inclusion. Out of the nine COVID-19 outcomes evaluated, there was significant associations between ACEIs/ARBs use and each of death (OR=0.80, 95%CI=0.75-0.86; I2=51.9%), death/ICU admission as composite outcome (OR=0.86, 95%CI=0.80-0.92; I2=43.9%), severe COVID-19 (OR=0.86, 95%CI=0.78-0.95; I2=68%), and hospitalisation (OR=1.23, 95%CI=1.04-1.46; I2= 76.4%). The significant reduction in death/ICU admission, however, was higher among studies which presented adjusted measure of effects (OR=0.63, 95%CI=0.47-0.84) and were of moderate quality (OR=0.74, 95%CI=0.63-0.85).Limitations The effect of unmeasured confounding could not be ruled out. Only 21.3% (n=10) of the studies were of ‘moderate’ quality.Conclusion Collective evidence from observational studies indicate a good quality evidence on the significant association between ACEIs/ARBs use and reduction in death and death/ICU admission, but poor-quality evidence on both reducing severe COVID-19 and increasing hospitalisation. Our findings further support the current recommendations of not discontinuing ACEIs/ARBs therapy in patients with COVID-19.Registration The study protocol was registered in PROSPERO (CRD42021233398).Funding Source None.
Medienart: |
Preprint |
---|
Erscheinungsjahr: |
2023 |
---|---|
Erschienen: |
2023 |
Enthalten in: |
bioRxiv.org - (2023) vom: 19. Nov. Zur Gesamtaufnahme - year:2023 |
---|
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Kurdi, Amanj [VerfasserIn] |
---|
Links: |
Volltext [kostenfrei] |
---|
Themen: |
---|
doi: |
10.1101/2022.03.20.22272664 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
XBI035567376 |
---|
LEADER | 01000caa a22002652 4500 | ||
---|---|---|---|
001 | XBI035567376 | ||
003 | DE-627 | ||
005 | 20231205150154.0 | ||
007 | cr uuu---uuuuu | ||
008 | 220324s2023 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1101/2022.03.20.22272664 |2 doi | |
035 | |a (DE-627)XBI035567376 | ||
035 | |a (biorXiv)10.1101/2022.03.20.22272664 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Kurdi, Amanj |e verfasserin |0 (orcid)0000-0001-5036-1988 |4 aut | |
245 | 1 | 0 | |a An umbrella review and meta-analysis of the use of renin-angiotensin system drugs and COVID-19 outcomes: what do we know so far? |
264 | 1 | |c 2023 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a Computermedien |b c |2 rdamedia | ||
338 | |a Online-Ressource |b cr |2 rdacarrier | ||
520 | |a Abstract Backgrounds Evidence from several meta-analyses are still controversial about the effects of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin-receptor blockers (ARBs) on COVID-19 outcomes.Purpose Umbrella review of systematic reviews/meta-analysis to provide comprehensive assessment of the effect of ACEIs/ARBs on COVID-19 related outcomes by summarising the currently available evidence.Data Source Medline (OVID), Embase, Scopus, Cochrane library and medRxiv from inception to 1stFebruary 2021.Study Selection Systematic reviews with meta-analysis that evaluated the effect of ACEIs/ARBs on COVID-19 related clinical outcomesData Extraction Two reviewers independently extracted the data and assessed studies’ risk of bias using AMSTAR 2 Critical Appraisal Tool.Data Synthesis Pooled estimates were combined using the random-effects meta-analyses model including several sub-group analyses. Overall, 47 reviews were eligible for inclusion. Out of the nine COVID-19 outcomes evaluated, there was significant associations between ACEIs/ARBs use and each of death (OR=0.80, 95%CI=0.75-0.86; I2=51.9%), death/ICU admission as composite outcome (OR=0.86, 95%CI=0.80-0.92; I2=43.9%), severe COVID-19 (OR=0.86, 95%CI=0.78-0.95; I2=68%), and hospitalisation (OR=1.23, 95%CI=1.04-1.46; I2= 76.4%). The significant reduction in death/ICU admission, however, was higher among studies which presented adjusted measure of effects (OR=0.63, 95%CI=0.47-0.84) and were of moderate quality (OR=0.74, 95%CI=0.63-0.85).Limitations The effect of unmeasured confounding could not be ruled out. Only 21.3% (n=10) of the studies were of ‘moderate’ quality.Conclusion Collective evidence from observational studies indicate a good quality evidence on the significant association between ACEIs/ARBs use and reduction in death and death/ICU admission, but poor-quality evidence on both reducing severe COVID-19 and increasing hospitalisation. Our findings further support the current recommendations of not discontinuing ACEIs/ARBs therapy in patients with COVID-19.Registration The study protocol was registered in PROSPERO (CRD42021233398).Funding Source None | ||
650 | 4 | |a Biology |7 (dpeaa)DE-84 | |
650 | 4 | |a 570 |7 (dpeaa)DE-84 | |
700 | 1 | |a Weir, Natalie |4 aut | |
700 | 1 | |a Mueller, Tanja |0 (orcid)0000-0002-0418-4789 |4 aut | |
773 | 0 | 8 | |i Enthalten in |t bioRxiv.org |g (2023) vom: 19. Nov. |
773 | 1 | 8 | |g year:2023 |g day:19 |g month:11 |
856 | 4 | 0 | |u http://dx.doi.org/10.1101/2022.03.20.22272664 |z kostenfrei |3 Volltext |
912 | |a GBV_XBI | ||
951 | |a AR | ||
952 | |j 2023 |b 19 |c 11 |