AUTHOR=Singh Romil , Rathore Sawai Singh , Khan Hira , Bhurwal Abhishek , Sheraton Mack , Ghosh Prithwish , Anand Sohini , Makadia Janaki , Ayesha Fnu , Mahapure Kiran S. , Mehra Ishita , Tekin Aysun , Kashyap Rahul , Bansal Vikas 

TITLE=Mortality and Severity in COVID-19 Patients on ACEIs and ARBs—A Systematic Review, Meta-Analysis, and Meta-Regression Analysis

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.703661

DOI=10.3389/fmed.2021.703661

ISSN=2296-858X

ABSTRACT=<p><bold>Purpose:</bold> The primary objective of this systematic review is to assess association of mortality in COVID-19 patients on Angiotensin-converting-enzyme inhibitors (ACEIs) and Angiotensin-II receptor blockers (ARBs). A secondary objective is to assess associations with higher severity of the disease in COVID-19 patients.</p><p><bold>Materials and Methods:</bold> We searched multiple COVID-19 databases (WHO, CDC, LIT-COVID) for longitudinal studies globally reporting mortality and severity published before January 18th, 2021. Meta-analyses were performed using 53 studies for mortality outcome and 43 for the severity outcome. Mantel-Haenszel odds ratios were generated to describe overall effect size using random effect models. To account for between study results variations, multivariate meta-regression was performed with preselected covariates using maximum likelihood method for both the mortality and severity models.</p><p><bold>Result:</bold> Our findings showed that the use of ACEIs/ARBs did not significantly influence either mortality (OR = 1.16 95% CI 0.94–1.44, <italic>p</italic> = 0.15, <italic>I</italic><sup>2</sup> = 93.2%) or severity (OR = 1.18, 95% CI 0.94–1.48, <italic>p</italic> = 0.15, <italic>I</italic><sup>2</sup> = 91.1%) in comparison to not being on ACEIs/ARBs in COVID-19 positive patients. Multivariate meta-regression for the mortality model demonstrated that 36% of between study variations could be explained by differences in age, gender, and proportion of heart diseases in the study samples. Multivariate meta-regression for the severity model demonstrated that 8% of between study variations could be explained by differences in age, proportion of diabetes, heart disease and study country in the study samples.</p><p><bold>Conclusion:</bold> We found no association of mortality or severity in COVID-19 patients taking ACEIs/ARBs.</p>