3.0 Results:
This meta-analysis includes patients from six studies with confirmed SARS-CoV-2 infection, and compares the outcomes among 423 patients receiving ACEi/ARB with 1419 patients who did not receive ACEi/ARB. Bean et al analysed patients who were on ACEi only, and Liu et al, on ARB only. The other studies did not segregate between patients on either ACEi or ARB. Hence, we have pooled the data and conducted this meta-analysis on the combined effect of ACEi/ARB.
The odds for risk of severity of disease was analysed from data extracted from all the six citations. The data from the study by Bean et al was included only for the analysis of the effect of ACEi/ARB on the risk of severity of disease as the odds ratio for this outcome in patients on ACEi was clearly mentioned in their publication; we could not include their data on effect on death since this was not reported separately as an outcome. (20). Similarly, data from the study of Liu et al (12) did not report on death separately. As such, the odds for death was analysed from the data extracted from the studies of Yang et al, Zeng et al, Zhang et al, and Li et al (17,19, 22). The odds for risk for hospitalisation was analysed from the data extracted from the studies of Yang et al (19) and Zeng et al (17) only, since the other four studies did not report on this outcome.
In view of the numerous terminologies used to report various end points in the six studies include in this analysis, we chose to assess the effect of ACEi/ARB on the risk of severity of disease. The data on death in the four studies was homogeneous as was the data on risk for hospitalisation among the two studies. The baseline characteristics of the studies are compiled in table 1. [Table 1]
3.1 Effect of use of ACEi/ARB in patients with COVID-19 on risk of severity of disease (Figure 2):
There was a 38% statistically non-significant reduction in the odds of risk of severity of disease in patients with COVID-19 in the ACEi/ARB group compared to those not on ACEi/ARB (95% CI: 0.31-1.23, I2=70.36). There was moderate degree of heterogeneity.