COVID-19 first and delta waves in relation to ACEI, ARB, Influenza vaccination, and comorbidity in a North Metropolitan Barcelona Health Consortium

  1. Marta Juanes-González
  2. Ana Calderón-Valdiviezo
  3. Helena Losa-Puig
  4. Roger Valls-Foix
  5. Marta González-Salvador
  6. Marc León-Pérez
  7. Luís Pueyo-Antón
  8. Celia Lozano-Paz
  9. Maite Franco-Romero
  10. Josep Vidal-Alaball
  11. Anna Puigdellívol-Sánchez

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Abstract

BACKGROUND

Some authors have reported that angiotensin converter enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) improve clinical outcomes in hypertensive COVID-19 patients, and others have proposed cross-protection for influenza vaccination. This study explores the impact of these variables on the evolution of hospitalized patients, focusing in the first wave and the Delta wave.

METHODS

Hospitalizations (n=1888) from March 1, 2020, to July 31, 2021, in the Hospital of Terrassa, the referral center for the free access Terrassa Health Consortium in the North Metropolitan Barcelona Health Region (population=167,386) were studied. The number of chronic treatments and conditions of patients from the initial outbreak (n=184) and the Delta outbreak (n=158) were recorded.

RESULTS

Of the non-survivors, 96.3% were aged >60 years in the first wave and 100% were aged >70 years in the Delta wave. In non-survival hospitalized patients aged >60 years, the percentage treated with ACEI was similar to general population but was significantly different for ARB treatments of influenza vaccination, although associated to a higher comorbidity and age. In July 2021, the number of hospitalizations for patients aged <50 years was higher than March 2020 and 22% of hospitalized patients without chronic treatments and conditions needed admission to the intensive care unit. Mortality was reduced in the groups with most comorbidities who received influenza and SARS-CoV2 vaccination.

CONCLUSIONS

In COVID-19 infection, age and comorbidity are related to survival, ACEI use is safe. A high proportion of patients without comorbidity require hospitalization and intensive care.

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  1. ScreenIT

    SciScore for 10.1101/2021.11.17.21265440: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study was approved by the ethics committee of the Terrassa Health Consortium (THC) on April 8 (ref 02-20-161-021) and the observational clinical trial was posted on April 29 (NCT 04367883).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The types of chronic treatments were classified according to the Anatomical Therapeutic Chemical (ATC) classification system [12].
    ATC
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: One limitation of the study is the lack of a gold standard technique for confirming COVID-19. False-negative rates of 38% on the day of symptom onset and 20% three days later have been reported [30] during 2020. Consequently, other than when analyzing the relationship with vaccination and comorbidity, we only included PCR-positive cases (Table 2). In 2021, all cases had positive antigen or PCR tests, suggesting that the diagnostic techniques have improved this year in real-world setting. Another limitation is that a second private hospital services the same health region as the THC, meaning that hospitalization rates could be underestimated. Nevertheless, it is feasible that the patients diagnosed in the other facility were comparable to our own.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04367883RecruitingInfluenza Vaccination, ACEI and ARB in the Evolution of SARS…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.11.17.21265440v2 on medRxiv
  3. Version published to 10.1101/2021.11.17.21265440v1 on medRxiv