1Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
2Seoul National University Hospital and Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Copyright © 2017 The Korean Society of Critical Care Medicine
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Values are presented as mean ± standard deviation or number (%).
RAS: renin-angiotensin system; COPD: chronic obstructive pulmonary disease; ARDS: acute respiratory distress syndrome; PF: PaO2/FiO2; APACHE: Acute Physiology and Chronic Health Evaluation; SOFA: Sequential Organ Failure Assessment; PEEP: positive end-expiratory pressure; CRRT: continuous renal replacement therapy.
COVID-19: The Influence of ACE Genotype and ACE-I and ARBs on the Course of SARS-CoV-2 Infection in Elderly Patients
Role of Renin-Angiotensin System in Acute Lung Injury Caused by Viral Infection
Variable | Unmatched cohort |
Propensity matched cohort |
||||
---|---|---|---|---|---|---|
Non-RAS inhibitor group (n = 145) | RAS inhibitor group (n = 37) | P-value | Non-RAS inhibitor group (n = 34) | RAS inhibitor group (n = 34) | P-value | |
Age (yr) | 63.3 ± 13.7 | 67.4 ± 13.5 | 0.104 | 70.1 ± 13.7 | 68.1 ± 12.2 | 0.514 |
Male sex | 106 (73.1) | 28 (75.7) | 0.751 | 27 (79.4) | 25 (73.5) | 0.567 |
Comorbidity | ||||||
Hypertension | 34 (23.5) | 20 (54.1) | <0.001 | 14 (41.2) | 15 (44.1) | 0.806 |
Diabetes | 39 (26.9) | 13 (35.1) | 0.322 | 10 (29.4) | 13 (38.2) | 0.442 |
Coronary artery disease | 11 (7.6) | 5 (13.5) | 0.256 | 5 (14.7) | 5 (14.7) | 1.000 |
COPD | 9 (6.2) | 2 (5.4) | 0.855 | 1 (2.9) | 2 (5.9) | 0.555 |
Tuberculosis | 25 (17.2) | 4 (10.8) | 0.340 | 7 (20.6) | 4 (11.8) | 0.323 |
Chronic liver disease | 17 (11.7) | 2 (5.4) | 0.262 | 1 (2.9) | 2 (5.9) | 0.555 |
Chronic kidney disease | 8 (5.5) | 12 (32.4) | <0.001 | 8 (23.5) | 11 (32.4) | 0.417 |
Cerebral vascular accident | 7 (4.8) | 4 (10.8) | 0.173 | 4 (11.8) | 3 (8.8) | 0.690 |
Malignancy | 92 (63.5) | 12 (35.3) | 0.003 | 10 (29.4) | 12 (35.3) | 0.604 |
Pulmonary | 17 (18.5) | 3 (25.0) | 0.590 | 3 (30.0) | 3 (25.0) | 0.793 |
Extrapulmonary | 75 (81.5) | 9 (75) | - | 7 (70.0) | 9 (75.0) | - |
Injury mechanism | 0.789 | 1.000 | ||||
Direct | 127 (87.6) | 33 (89.2) | 30 (88.2) | 30 (88.2) | ||
Indirect | 18 (12.4) | 4 (10.8) | 4 (11.8) | 4 (11.8) | ||
ARDS severity | 0.431 | 0.200 | ||||
Mild | 7 (4.8) | 3 (8.6) | 0 | 3 (8.8) | ||
Moderate | 70 (47.6) | 13 (37.1) | 12 (35.3) | 12 (35.3) | ||
Severe | 70 (47.6) | 19 (54.3) | 22 (64.7) | 22 (64.7) | ||
PF ratio | ||||||
Initial | 112.2 ± 45.4 | 103.1 ± 51.7 | 0.297 | 93.9 ± 33.4 | 103.0 ± 53.6 | 0.407 |
24 hr after admission | 144.5 ± 73.0 | 144.9 ± 69.9 | 0.974 | 133.4 ± 68.2 | 149.2 ± 71.1 | 0.353 |
72 hr after admission | 173.1 ± 90.9 | 187.8 ± 113.6 | 0.408 | 150.1 ± 81.8 | 193.8 ± 116.1 | 0.081 |
Discharge day | 141.5 ± 114.3 | 164.6 ± 124.2 | 0.282 | 132.9 ± 113.4 | 173.3 ± 125.8 | 0.168 |
APACHE II score | 31.5 ± 6.2 | 30.3 ± 5.2 | 0.316 | 29.5 ± 6.8 | 30.2 ± 5.0 | 0.612 |
SOFA score | ||||||
Initial | 11.1 ± 2.9 | 10.8 ± 2.5 | 0.542 | 10.1 ± 2.7 | 10.6 ± 2.5 | 0.462 |
48 hr after admission | 10.9 ± 3.8 | 9.5 ± 2.5 | 0.031 | 11.1 ± 4.1 | 9.4 ± 2.3 | 0.051 |
96 hr after admission | 10.2 ± 3.8 | 9.3 ± 2.8 | 0.190 | 10.1 ± 3.9 | 9.1 ± 2.7 | 0.246 |
Mechanical ventilation | ||||||
PEEP (cmH2O) | 6.9 ± 2.6 | 6.9 ± 2.6 | 0.681 | 7.6 ± 2.9 | 6.7 ± 2.6 | 0.184 |
Pressure above PEEP (cmH2O) | 18.9 ± 4.7 | 18.8 ± 4.2 | 0.845 | 18.8 ± 4.2 | 18.4 ± 3.9 | 0.639 |
FiO2 | 0.71 ± 0.21 | 0.71 ± 0.19 | 0.928 | 0.75 ± 0.19 | 0.71 ± 0.20 | 0.351 |
Tidal volume (ml/kg) | 7.4 ± 1.9 | 7.5 ± 1.9 | 0.774 | 7.3 ± 2.0 | 7.5 ± 1.9 | 0.612 |
Minute volume (L) | 9.8 ± 2.9 | 9.5 ± 3.0 | 0.603 | 8.8 ± 2.8 | 9.5 ± 3.1 | 0.382 |
Steroid | 89 (61.4) | 21 (56.8) | 0.608 | 14 (41.2) | 19 (55.9) | 0.225 |
CRRT | 34 (23.5) | 7 (18.9) | 0.556 | 7 (20.6) | 6 (17.7) | 0.758 |
NO gas | 56 (38.6) | 17 (46.0) | 0.417 | 13 (38.2) | 15 (44.1) | 0.622 |
Inotropics | 131 (90.3) | 29 (78.4) | 0.046 | 30 (88.2) | 26 (76.5) | 0.203 |
Cause | Total (n = 182) | Non-RAS inhibitor group (n = 145) | RAS inhibitor group (n = 37) |
---|---|---|---|
Pulmonary | |||
Pneumonia | 136 (74.7) | 112 (76.2) | 24 (68.6) |
Hemorrhage | 10 (5.5) | 6 (4.1) | 4 (11.4) |
Exacerbation of ILD | 4 (2.8) | 3 (2.0) | 2 (5.7) |
Extrapulmonary | |||
Bacteremia | 11 (6.0) | 10 (6.8) | 1 (2.9) |
Postoperative | 5 (2.75) | 2 (1.4) | 3 (8.6) |
Transfusion related | 4 (2.2) | 4 (2.2) | 0 |
Drug related | 2 (1.1) | 2 (1.4) | 0 |
Radiation related | 1 (0.6) | 1 (0.7) | 0 |
Unknown | 8 (4.4) | 7 (4.8) | 1 (2.9) |
Variable | Unmatched cohort |
Propensity matched cohort |
||||
---|---|---|---|---|---|---|
Non-RAS inhibitor group (n = 145) | RAS inhibitor group (n = 37) | P-value | Non-RAS inhibitor group (n = 34) | RAS inhibitor group (n = 34) | P-value | |
Duration of mechanical ventilation (d) | 19.5 ± 21.9 | 29.5 ± 20.8 | 0.013 | 16.4 ± 8.6 | 30.2 ± 21.5 | <0.001 |
Radiologic improvement | 69 (47.6) | 22 (59.5) | 0.197 | 17 (50.0) | 21 (61.8) | 0.329 |
ICU readmission | 4 (2.8) | 2 (5.4) | 0.421 | 2 (5.9) | 4 (11.8) | 0.393 |
ICU day | 20.2 ± 15.7 | 32.1 ± 21.7 | <0.001 | 19.9 ± 10.9 | 33.6 ± 23.1 | 0.003 |
Hospital day | 58.0 ± 90.1 | 89.8 ± 111.2 | 0.070 | 43.8 ± 31.2 | 94.7 ± 114.7 | 0.015 |
ICU-free day, 28 days | 5.2 ± 8.1 | 4.8 ± 7.7 | 0.822 | 5.1 ± 7.6 | 4.9 ± 7.8 | 0.962 |
ICU-free day, 90 days | 29.4 ± 36.4 | 34.2 ± 33.8 | 0.481 | 32.4 ± 37.3 | 35.2 ± 33.8 | 0.747 |
Hospital-free day, 90 days | 16.2 ± 25.9 | 14.2 ± 24.9 | 0.685 | 16.6 ± 25.3 | 14.6 ± 25.2 | 0.749 |
Ventilator-free day, 28 days | 6.4 ± 8.9 | 6.1 ± 8.9 | 0.898 | 7.1 ± 8.9 | 6.3 ± 8.9 | 0.737 |
Mortality | ||||||
In ICU mortality | 85 (58.6) | 17 (46.0) | 0.166 | 19 (55.9) | 14 (41.2) | 0.225 |
In hospital mortality | 95 (65.5) | 21 (56.8) | 0.322 | 20 (58.8) | 18 (52.9) | 0.625 |
At day 28 | 51 (35.2) | 7 (18.9) | 0.058 | 10 (29.4) | 3 (8.8) | 0.031 |
At day 90 | 82 (56.6) | 16 (43.2) | 0.147 | 18 (52.9) | 13 (38.2) | 0.223 |
Tracheostomy | 41 (28.3) | 17 (46.0) | 0.040 | 12 (35.3) | 16 (47.1) | 0.324 |
Change to portable BiPAP | 8 (5.5) | 7 (18.9) | 0.008 | 2 (5.9) | 7 (20.6) | 0.074 |
Reintubation | 25 (17.2) | 7 (18.9) | 0.735 | 6 (17.7) | 6 (17.7) | 1.000 |
Values are presented as mean ± standard deviation or number (%). RAS: renin-angiotensin system; COPD: chronic obstructive pulmonary disease; ARDS: acute respiratory distress syndrome; PF: PaO2/FiO2; APACHE: Acute Physiology and Chronic Health Evaluation; SOFA: Sequential Organ Failure Assessment; PEEP: positive end-expiratory pressure; CRRT: continuous renal replacement therapy.
Values are presented as number (%). ICU: intensive care unit; RAS: renin-angiotensin system; ILD: interstitial lung disease.
Values are presented as mean ± standard deviation or number (%). RAS: renin-angiotensin system; ICU: intensive care unit; BiPAP: bilevel positive airway pressure.