Study population and data collection
This study was approved by the University of Health Sciences Haydarpasa Numune Training and Research Hospital’s Ethical Committee. Written informed consent was waived by the local ethical committee due to the retrospective non-interventional nature of this study. In our study, electronic medical records and emergency department archives of patients with COVID-19 who were hospitalized in Haydarpaşa Numune Hospital analyzed during three months from March 2020, retrospectively. Haydarpaşa Numune Hospital is a tertiary care center, and approximately 200000-250000 patients apply to the emergency clinic in a year. In accordance with the literature, the COVID-19 clinical classification was made as mild, moderate, severe and critically ill cases9. Mild cases without signs of pneumonia were not included in this study. Moderated cases were accepted as patients with symptoms related to the respiratory system and pneumonia detected on imaging. Respiratory rate ≥ 30 breaths/min; SpO2 ≤ 93% at rest; and PaO2 / FIO2 ≤ 300, patients who developed respiratory failure, mechanical ventilator need, shock or multiorgan failure were included in the severe and critically ill cases group. In this study, patients whose moderate or severe/critically ill COVID-19 pneumonia diagnoses were confirmed from their medical records and who were using antihypertensive drugs due to hypertension were included in this study. Patients who were not diagnosed with hypertension but who used ACEIs due to congestive heart failure or diabetic nephropathy were excluded from this study. The diagnosis of COVID-19 pneumonia was confirmed in patients presenting with respiratory symptoms in accordance with the literature by the presence of pulmonary computed tomography findings showing viral pneumonia and by the positive viral nucleic acid test (RT-PCR) performed on oropharyngeal and nasopharyngeal swab samples. Radiological findings suggesting COVID-19 pneumonia were accepted as parenchymal multilobar lung lesions, ground-glass opacities, crazy paving sign, and peripheral distribution detected in pulmonary computed tomography10-12.
By examining the medical and nursing records of the patients, their age, sex, comorbid diseases, complaints during admission, duration of symptoms, vital signs at the time of admission to the emergency clinic (systolic blood pressure, body temperature, oxygen saturation, heart rate), D-dimer, ferritin, CRP, leukocyte, lymphocyte and procalcitonin levels, medications used by the patient, ward or intensive care follow-up notes and clinical outcomes (mortality or discharge) were noted. Findings seen on pulmonary computed tomography were evaluated by two independent physicians who were blinded to the clinical outcomes of the patients. Radiological findings were classified as bilateral or unilateral parenchymal opacities, bilateral or unilateral ground glass appearance, and multilobar involvement.
Two researchers reviewed the case report forms independently to double-check the collected data. Patients whose epidemiological, laboratory or symptomatic information could not be found in electronic medical records, emergency department archives, or nurse records were excluded from this study.
After the collected data were organized, the patients included in this study were divided into two groups as patients who used ACEIs and patients who did not use ACEIs. The epidemiological characteristics, vital signs, comorbid diseases, and mortality rates of the two groups were compared with each other.