A Meta-Analysis of the Impact of Using ACEIs or ARBs on Mortality, Severity, and Healthcare Resource Utilization in Patients with COVID-19

Objective: The primary objective of this study is to explore the potential link between the utilization of ACEIs or ARBs and its impact on mortality rates, disease severity, and healthcare resource utilization in individuals diagnosed with COVID-19. By conducting this research, we aim to establish a solid theoretical foundation for the safe and effective clinical administration of these medications. Method: we conducted a comprehensive search of various databases, including CNKI, PubMed, Springer, Web of Science, and Embase. We also traced the literature of the included studies to ensure a thorough analysis of the available evidence. After applying a set of predefined inclusion and exclusion criteria, we ultimately included a total of 41 articles in our analysis. To determine the overall effect size for dichotomous variables, we used the Mantel-Haenszel odds ratio in random effect models. For continuous variables, we calculated the inverse variance SMD using random effect models. To assess the outcomes and heterogeneity, we considered p-values (p<0.05) and I2 values for all outcomes. We performed multivariate and univariate meta-regression analyses using the maximum likelihood approach with the CMA 3.0 software. Results: The results of our analysis indicated that the use of ACEIs or ARBs did not significantly influence mortality (OR=1.10, 95% CI 0.83-1.46, p=0.43, I2=84%), severity (OR=0.99, 95% CI 0.68-1.45, p=0.98, I2=84%) and healthcare resource utilization (SMD=0.03, 95% CI-0.06-0.12, p=0.54, I2=37%) in patients with COVID-19 compared to those not taking ACEIs or ARBs. The multivariate meta-regression analysis model explained 63%, 31%, and 100% of the sources of heterogeneity for the three outcome indicators. Conclusions: The use of ACEIs and ARBs is not significantly correlated with mortality, severity and healthcare resource utilization in patients with COVID-19, indicating safe clinical use of the medications.