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• W4387249620 abstract "SESSION TITLE: Critical Care Posters 7 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: SARS-CoV-2 (COVID-19) virus cell entry is mediated by the angiotensin-converting enzyme 2 receptor (ACE2), which may be upregulated by renin-angiotensin-aldosterone system inhibitors (RAASi). In the absence of high-quality prospective trials, it remains unclear whether the use of RAASi has any effect on the outcomes of patients with COVID-19 infection. Also, due to platelet activation in the setting of endothelial injury and inflammation, it has been hypothesized that antiplatelet therapy (APT) may have a protective effect. METHODS: We analyzed 692 patients who tested positive for COVID-19 in the Emergency Department of University of Miami Hospital from March 1, 2020 to December 31, 2020. Charts were reviewed for RAASi (ACE inhibitor (ACEi) or angiotensin receptor blockers (ARB)) and APT (aspirin and clopidogrel) use. Only patients who had been taking an ACEi or ARB for at least six months prior to testing positive were selected for the analysis. Patients sent home to quarantine were asked to enroll in a telephone survey. Survey questions included nature and duration symptoms, admission to other hospitals, and medications. Permission was obtained to interview close contacts with whom they shared a bedroom and they were posed the same survey questions. Binary logistic regression analysis was performed to calculate hospital and ICU admission likelihood, and need for mechanical ventilation. Odds ratios were adjusted (aOR) by age (≥ 65 years old), gender, race, immunosuppression and comorbidity prevalence. RESULTS: Patients included 348 (50.3%) taking RAASi, 187 (27%) aspirin, and 40 (5.8%) clopidogrel. Use of RAASi and APT was not associated with increased hospitalization or ICU admission. However, pooled ACEi or ARB use was associated with a decreased rate of mechanical ventilation (aOR, 0.40; 95% CI 0.17-0.93) and stratified ACEi (aOR, 0.80; 95% CI 0.31-2.09) or ARB (aOR, 0.35; 95% CI 0.12-1.07) use showed a non-significant trend towards a decreased mechanical ventilation rate. Of patients sent home to quarantine, 89 were enrolled in the telephone survey. Patients taking ACEi had a shorter duration of symptoms (15.9 ±4.32 vs 31.4 ±5.9 days; p=0.037) but had no other significant differences. The infectivity rate among close contacts of interviewed (n=18) patients was 50% of which 44% (4 of 9) reported no symptoms. No significant difference in infection likelihood or disease severity were observed. CONCLUSIONS: No significant differences were observed for infectivity, hospital admission, or ICU admission between RAASi or APT users and non users. RAASi were associated with decreased rates of mechanical ventilation. ACEi use was associated with fewer total days of symptoms based on telephone survey data. CLINICAL IMPLICATIONS: Our study supports current guidelines to not discontinue RAASi in the setting of COVID-19 infection. Contrary to prior studies, APT failed to demonstrate any protective benefit. DISCLOSURES: No relevant relationships by Felipe De Andrade Arnaud No relevant relationships by Robert Flowers No relevant relationships by David Goldenberg No relevant relationships by Adhiraj Gosine No relevant relationships by Neil Kumar No relevant relationships by Arnaldo Lopez Ruiz No relevant relationships by Justin Medina No relevant relationships by Joel Mintz No relevant relationships by Andrew Quartin No relevant relationships by Guil Rozenbaum Lerner No relevant relationships by Rachel Werne No relevant relationships by Catherine Zaw" @default.
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• W4387249620 date "2023-10-01" @default.
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• W4387249620 title "THE ASSOCIATION OF RENIN-ANGIOTENSIN-ALDOSTERONE INHIBITORS AND ANTIPLATELET AGENTS WITH THE INFECTIVITY AND SEVERITY OF COVID-19: RETROSPECTIVE OBSERVATIONAL STUDY" @default.
• W4387249620 doi "https://doi.org/10.1016/j.chest.2023.07.1094" @default.
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