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Aug 4, 2023Keywords:
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Effect of ACE2 expression inhibiting drugs on COVID-19 disease severity, outcome and length of admission in Ethiopian patients: A causal inference using marginal structural model with inverse probability weight
Abstract
Background: There are varying and contradicting reports and in the face of lack of evidence generated on the effect of ACE2 (Angiotensin-converting enzyme inhibitors) expression inhibiting drugs on COVID-19 Disease. The aim of this study was to assess the effect of acute or chronic ACEIs, ARBs (Angiotensin receptor blockers) and/or NSAIDs (Nonsteroidal anti-inflammatory drugs) use on COVID-19 disease severity, outcome and length of admission among patients with COVID-19 admitted to the Millennium COVID-19 Care Center in Ethiopia.
Methods: A retrospective cohort study was conducted among 945 patients with COVID-19 who were on follow up from July 2nd to December 25th, 2020. Data was described using frequency tables and cross tabulations. To identify the effect of ACEIs, ARBs and/or NSAIDs use on COVID-19 disease severity, disease outcome and length of admission, Marginal Structural Model (MSM) with inverse probability weighting (IPW) approach was used.
Results: Among the 945 patients studied, 115 (12.2%) had a history of ACEIs, ARBs and/or NSAIDs use. At admission, the majority (39.6%) had mild disease and 272 (28.8%) had severe disease. Among the study participants, 900 (95.2%) were discharged improved and the rest 45 (4.8%) died. The median length of admission was 14.0 days (IQR, 13-16). Multinomial Logistic Regression, Log Binomial Regression and Negative Binomial Regression models were fitted to assess the effect of ACEIs, ARBs and/or NSAIDs use on disease severity, outcome and length of admission respectively. In all the three outcome models, ACEIs, ARBs and/or NSAIDs use didn’t show a statistically significant association with the outcomes.
Conclusion: Acute or chronic use of ACEIs, ARBs and/or NSAIDs showed no effect on COVID-19 disease severity, outcome and length of admission and therefore should not be withdrawn from patients who need these therapies unless new evidences proving clear contraindications emerge.
