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Ретроспективный анализ клинических исходов пациентов с COVID-19 в зависимости от получаемой антигипертензивной, гиполипидемической и сахароснижающей терапии
Демидова Т.Ю., Лобанова К.Г., Переходов С.Н., Анциферов М.Б., Ойноткинова О.Ш. Ретроспективный анализ клинических исходов пациентов с COVID-19 в зависимости от получаемой антигипертензивной, гиполипидемической и сахароснижающей терапии. Терапевтический архив. 2021; 93 (10): 1193–1202. DOI: 10.26442/00403660.2021.10.201072
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Demidova TYu, Lobanova KG, Perekhodov SN, Antsiferov MB, Oynotkinova OSh. Retrospective analysis of clinical outcomes of patients with COVID-19 depending on receiving antihypertensive, lipid-lowering and antihypertensive therapy. Terapevticheskii Arkhiv (Ter. Arkh). 2021; 93 (10): 1193–1202. DOI: 10.26442/00403660.2021.10.201072
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Аннотация
Обоснование. К основным факторам, увеличивающим риск сердечно-сосудистых катастроф и летальности среди пациентов с COVID-19, относят гипергликемию, артериальную гипертензию и дислипидемию. Следовательно, все пациенты с CОVID-19 и метаболическим синдромом должны получать антигипертензивную (АГТ), гиполипидемическую (ГЛТ) и сахароснижающую терапию (ССТ). В настоящее время имеется ограниченное количество исследований эффективности и безопасности данной терапии у пациентов с COVID-19, в том числе с сопутствующим сахарным диабетом (СД) 2-го типа.
Цель. Оценка клинических исходов пациентов с COVID-19 в зависимости от получаемой АГТ, ГЛТ и ССТ.
Материалы и методы. Проведен ретроспективный анализ клинических исходов «выписан/умер» 1753 пациентов с COVID-19 в зависимости от получаемой АГТ, ГЛТ и ССТ.
Результаты. Достоверное снижение риска летальности среди пациентов с COVID-19 отмечалось на фоне терапии ингибиторами ангиотензинпревращающего фермента/блокаторов рецепторов ангиотензина II – ИАПФ/БРА (отношение шансов – ОШ 0,39, 95% доверительный интервал – ДИ 0,21–0,72; р<0,05) и b-адреноблокаторами – b-АБ (ОШ 0,53, 95% ДИ 0,28–1; р<0,05). При этом на фоне терапии ИАПФ/БРА и b-АБ шанс смерти снижался более значимо среди пациентов с СД 2 по сравнению с пациентами без СД 2. Терапия диуретиками ассоциировалась с увеличением шансов смерти в 3 раза: ОШ 3,33, 95% ДИ 1,88–4,79; р<0,05. Терапия статинами не влияла на клинические исходы пациентов с COVID-19. На фоне терапии пероральными сахароснижающими препаратами риск смерти снижался в 5 раз (ОШ 0,19, 95% ДИ 0,07–0,54; р<0,05). На фоне инсулинотерапии отмечалось увеличение риска смерти в 2,8 раза (ОШ 2,81, 95% ДИ 1,5–5,29; р<0,05).
Заключение. Достоверное снижение летальности среди пациентов с COVID-19 отмечалось на фоне терапии ИАПФ/БРА, b-АБ, пероральными сахароснижающими препаратами. Увеличение риска смерти ассоциировано с инсулинотерапией и терапией диуретиками.
Ключевые слова: сахарный диабет 2-го типа, артериальная гипертензия, антигипертензивные препараты, сахароснижающие препараты, COVID-19, фавипиравир
Цель. Оценка клинических исходов пациентов с COVID-19 в зависимости от получаемой АГТ, ГЛТ и ССТ.
Материалы и методы. Проведен ретроспективный анализ клинических исходов «выписан/умер» 1753 пациентов с COVID-19 в зависимости от получаемой АГТ, ГЛТ и ССТ.
Результаты. Достоверное снижение риска летальности среди пациентов с COVID-19 отмечалось на фоне терапии ингибиторами ангиотензинпревращающего фермента/блокаторов рецепторов ангиотензина II – ИАПФ/БРА (отношение шансов – ОШ 0,39, 95% доверительный интервал – ДИ 0,21–0,72; р<0,05) и b-адреноблокаторами – b-АБ (ОШ 0,53, 95% ДИ 0,28–1; р<0,05). При этом на фоне терапии ИАПФ/БРА и b-АБ шанс смерти снижался более значимо среди пациентов с СД 2 по сравнению с пациентами без СД 2. Терапия диуретиками ассоциировалась с увеличением шансов смерти в 3 раза: ОШ 3,33, 95% ДИ 1,88–4,79; р<0,05. Терапия статинами не влияла на клинические исходы пациентов с COVID-19. На фоне терапии пероральными сахароснижающими препаратами риск смерти снижался в 5 раз (ОШ 0,19, 95% ДИ 0,07–0,54; р<0,05). На фоне инсулинотерапии отмечалось увеличение риска смерти в 2,8 раза (ОШ 2,81, 95% ДИ 1,5–5,29; р<0,05).
Заключение. Достоверное снижение летальности среди пациентов с COVID-19 отмечалось на фоне терапии ИАПФ/БРА, b-АБ, пероральными сахароснижающими препаратами. Увеличение риска смерти ассоциировано с инсулинотерапией и терапией диуретиками.
Ключевые слова: сахарный диабет 2-го типа, артериальная гипертензия, антигипертензивные препараты, сахароснижающие препараты, COVID-19, фавипиравир
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Background. The main factors that increase the risk of cardiovascular accidents and mortality among patients with COVID-19 include hyperglycemia, arterial hypertension and dyslipidemia. Therefore, all patients with COVID-19 and metabolic syndrome should receive antihypertensive (AHT), hypolipidemic (GLT) and hypoglycemic therapy (GGT). Currently, there is a limited number of studies regarding the effectiveness and safety of this therapy in patients with COVID-19.
Aim. Evaluate the clinical outcomes of patients with COVID-19, depending on the recipient of AHT, GLT and GGT.
Materials and methods. A retrospective analysis of the clinical outcomes "discharged/died" of 1753 patients with COVID-19 was carried out depending on the received AHT, GLT and GGT.
Results. A significant reduction in the risk of mortality among patients with COVID-19 was observed during therapy with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers – ACE inhibitors/ARBs (OR 0.39, 95% CI 0.21–0.72; p<0.05) and b-adrenergic blockers – b-AB (OR 0.53, 95% CI 0.28–1; p<0.05). At the same time, against the background of therapy with ACE inhibitors/ARBs and b-ABs, the chance of mortality decreased more significantly among patients with type 2 diabetes mellitus (T2DM) compared with patients without T2DM. Diuretic therapy was associated with a 3-fold increase in the chances of death: OR 3.33, 95% CI 1.88–4.79; p<0.05. Statin therapy did not affect clinical outcomes in COVID-19 patients. On the background of therapy with oral hypoglycemic drugs, the risk of mortality decreased 5-fold (OR 0.19, 95% CI 0.07–0.54; p<0.05). Against the background of insulin therapy, there was an increase in mortality risk by 2.8 times (OR 2.81, 95% CI 1.5–5.29; p<0.05).
Conclusion. A significant reduction in mortality among patients with COVID-19 was observed during therapy with ACEI/ARB, b-AB, and oral hypoglycemic therapy. Increased risk of death was associated with insulin therapy and diuretic therapy.
Keywords: type 2 diabetes mellitus, hypertension, antihypertensive drugs, hypoglycemic drugs, COVID-19, favipiravirum
Полный текст
Список литературы
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22. Baral R, White M, Vassiliou VS. Effect of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19: a Systematic Review and Meta-analysis of 28,872 Patients. Curr Atheroscler Rep. 2020;22(10):61. DOI:10.1007/s11883-020-00880-6
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31. Zhang X-J, Qin J-J, Cheng X, et al. In-Hospital Use of Statins Is Associated with a Reduced Risk of Mortality among Individuals with COVID-19. Cell Metab. 2020;32(2):176-187.e4. DOI:10.1016/j.cmet.2020.06.015
32. Singh AK, Khunti K. Assessment of risk, severity, mortality, glycemic control and antidiabetic agents in patients with diabetes and COVID-19: a narrative review. Diabetes Res Clin Pract. 2020;165:108266. DOI:10.1016/j.diabres.2020.108266
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34. Goyal A, Cardozo-Ojeda, Fabian E, Schiffer JT. Potency and timing of antiviral therapy as determinants of duration of SARS CoV-2 shedding and intensity of inflammatory response, medRxiv. 2020. DOI:10.1101/2020.04.10.20061325
35. Грановская М.В., Заславская К.Я., Балыкова Л.А., Пушкарь Д.Ю. COVID-19: набор симптомов или системная патология? Клиническая лекция. Часть 2. Арепливир (фавипиравир) в терапии пациентов с коронавирусной инфекцией: предпосылки для назначения и первые результаты использования. Инфекционные болезни: новости, мнения, обучение. 2020;9(3):10-7. [Granovskaya MV, Zaslavskaya KYa, Balykova LA, Pushkar DYu. A set of symptoms or a systemic pathology? Clinical lecture Part 2. Areplivir (favipiravir) in the treatment of patients with coronavirus infection: Background of use and first results. Infectious Diseases: News, Opinions, Training. 2020;9(3):10-7 (in Russian)]. DOI:10.33029/2305-3496-2020-9-3S-10-17
36. Preliminary report of the favipiravir observational study in Japan (2020/5/15). Favipiravir observational study group. Available at: http://www.kansensho.or.jp/uploads/files/topics/2019ncov/covid19_casereport_en_200529.pdf. Accessed: 11.05.2021.
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20. Kolabava ZhD, Konradi AO, Nedogoda SV, et al. Arterial hypertension in adults. Clinical guidelines. Russian Society of Cardiology, Moscow, 2020 (in Russian).
21. Dambha-Miller H, Albasri A, Hodgson S, et al. Currently prescribed drugs in the UK that could upregulate or downregulate ACE2 in COVID-19 disease: a systematic review. BMJ Open. 2020;10(9):e040644. DOI:10.1136/bmjopen-2020-040644
22. Baral R, White M, Vassiliou VS. Effect of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19: a Systematic Review and Meta-analysis of 28,872 Patients. Curr Atheroscler Rep. 2020;22(10):61. DOI:10.1007/s11883-020-00880-6
23. Shestakova MV, Vikulova OK, Isakov MA, Dedov II. Diabetes and COVID-19: analysis of the clinical outcomes according to the data of the Russian Diabetes Registry. Problems of Endocrinology. 2020;66(1):35-46. (in Russian). DOI:10.14341/probl12458
24. De Simone G. 2020. Position statement of the ESC Council on hypertension on ACE-inhibitors and angiotensin receptor blockers. Available at: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-c.... Accessed: 11.05.2021.
25. Bozkurt B, Kovacs R, Harrington B. 2020. HFSA/ACC/AHA statement addresses concerns re: using RAAS antagonists in COVID-19. Available at: https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-.... Accessed: 11.05.2021.
26. Yan H, Valdes AM, Vijay A, et al. Role of Drugs Used for Chronic Disease Management on Susceptibility and Severity of COVID-19: A Large Case-Control Study. Clin Pharmacol Ther. 2020. DOI:10.1002/cpt.2047
27. Liu X, Liu Y, Chen K, et al. Efficacy of ACEIs/ARBs versus CCBs on the progression of COVID‐19 patients with hypertension in Wuhan: A hospital‐based retrospective cohort study. J Med Virol. 2020:10.1002/jmv.26315. DOI:10.1002/jmv.26315
28. Neuraz A, Lerner I, Digan W, et al. Natural language processing for rapid response to emergent diseases: case study of calcium channel blockers and hypertension in the COVID-19 pandemic. J Med Internet Res. 2020;22(8):e20773. DOI:10.2196/20773
29. Eroğlu I, Çelik Eroğlu B, Uyaroğlu OA, Sain Güven G. Blocking angiotensin earlier with RAS blockers, statins, and heparin in high-risk COVID-19 patients: Is the remedy here? Anatol J Cardiol. 2020;24(1):19-20. DOI:10.14744/AnatolJCardiol.2020.73232
30. Dashti‐Khavidaki S, Khalili H. Considerations for Statin Therapy in Patients with COVID‐19. Pharmacotherapy. 2020;40(5):484-6. DOI:10.1002/phar.2397
31. Zhang X-J, Qin J-J, Cheng X, et al. In-Hospital Use of Statins Is Associated with a Reduced Risk of Mortality among Individuals with COVID-19. Cell Metab. 2020;32(2):176-187.e4. DOI:10.1016/j.cmet.2020.06.015
32. Singh AK, Khunti K. Assessment of risk, severity, mortality, glycemic control and antidiabetic agents in patients with diabetes and COVID-19: a narrative review. Diabetes Res Clin Pract. 2020;165:108266. DOI:10.1016/j.diabres.2020.108266
33. Ministry of Health of the Russian Federation. Temporary guidelines. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 11 (05/07/2021) (in Russian).
34. Goyal A, Cardozo-Ojeda, Fabian E, Schiffer JT. Potency and timing of antiviral therapy as determinants of duration of SARS CoV-2 shedding and intensity of inflammatory response, medRxiv. 2020. DOI:10.1101/2020.04.10.20061325
35. Granovskaya MV, Zaslavskaya KYa, Balykova LA, Pushkar DYu. A set of symptoms or a systemic pathology? Clinical lecture Part 2. Areplivir (favipiravir) in the treatment of patients with coronavirus infection: Background of use and first results. Infectious Diseases: News, Opinions, Training. 2020;9(3):10-7 (in Russian). DOI:10.33029/2305-3496-2020-9-3S-10-17
36. Preliminary report of the favipiravir observational study in Japan (2020/5/15). Favipiravir observational study group. Available at: http://www.kansensho.or.jp/uploads/files/topics/2019ncov/covid19_casereport_en_200529.pdf. Accessed: 11.05.2021.
Авторы
Т.Ю. Демидова1, К.Г. Лобанова*1, С.Н. Переходов2, М.Б. Анциферов3, О.Ш. Ойноткинова1
1 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ГБУЗ «Городская клиническая больница им. В.П. Демихова» Департамента здравоохранения г. Москвы, Москва, Россия;
3 ГБУЗ «Эндокринологический диспансер» Департамента здравоохранения г. Москвы, Москва, Россия
*miss.sapog@mail.ru
1 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ГБУЗ «Городская клиническая больница им. В.П. Демихова» Департамента здравоохранения г. Москвы, Москва, Россия;
3 ГБУЗ «Эндокринологический диспансер» Департамента здравоохранения г. Москвы, Москва, Россия
*miss.sapog@mail.ru
________________________________________________
Tatiana Yu. Demidova1, Kristina G. Lobanova*1, Sergey N. Perekhodov2, Michail B. Antsiferov3, Olga Sh. Oynotkinova1
1 Pirogov Russian National Research Medical University, Moscow, Russia;
2 Demikhov Clinical City Hospital, Moscow, Russia;
3 Endocrinological Dispensary, Moscow, Russia
*miss.sapog@mail.ru
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