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Table 1 Clinical characteristics, RAS peptides levels and outcomes in the total cohort

From: Renin–angiotensin system dysregulation in critically ill patients with acute respiratory distress syndrome due to COVID-19: a preliminary report

Variables

All (n = 32)

Survivors (n = 18)

Non-Survivors (n = 14)

P Value

Age, years, median (IQR)

73 (64–78)

69 (56–74)

78 (74–80)

0.001

Males N (%)

27 (84)

15 (84)

12 (86)

0.85

SAPS II score, median (IQR)

36 (23–42)

28 (19–36)

40 (31–56)

0.017

SOFA score at ICU admission, median (IQR)

3 (2–6)

3 (2–4)

4 (3–8)

0.115

PaO2/FiO2 ratio at study inclusion, median (IQR)

150 (127–179)

169 (132–181)

143 (113–153)

0.11

Noradrenaline at study inclusion, N (%)

12 (37.5)

4 (22)

8 (57)

0.07

Comorbidities, N (%)

Hypertension

16 (50)

9(50)

7 (50)

1

Cardiovascular disease

9 (28)

4 (22)

5 (36)

0.4

Chronic treatment with ACEi and/or ARBs, N (%)

11 (34.3)

4 (22.2)

7 (50)

0.25

ACEi and/or ARBs at study inclusion N (%)(‡)

4 (12.5)

2 (11.1)

2 (14.2)

1

ARDS (†) categories at study inclusion N (%)

Mild

9 (28)

5 (28)

4 (29)

1

Moderate

23 (72)

13 (72)

10 (71)

 

Respiratory support throughout the ICU stay N (%)

NIV/HFNC

11 (34)

11(61)

0 (0)

 < 0.0004

IMV

21 (66)

7 (39)

14 (100)

 

AKI (††) at study inclusion, N (%)

5 (15.6)

1 (5.5)

4 (28.5)

0.13

ICU LoS, days, median (IQR)

8.5 (5–17)

8 (4–13)

10.5 (7–18)

0.189

RAS peptides levels at study inclusion (*)

Renin, pg/mL median (IQR)

16.5 (6.27–105)

13 (4.47–31.77)

56.7 (11–255)

0.04

Angiotensin I, pg/mL, median (IQR)

655 (445–1175)

685 (580–1500)

475 (410–690)

0.03

Angiotensin II, pg/mL, median (IQR)

350 (230–650)

470 (300–920)

250 (220–350)

0.01

Angiotensin 1–7, pg/mL, median (IQR) (**)

230 (170–350)

320 (210–440)

210 (160–250)

0.023

Angiotensin I/Angiotensin II ratio, median (IQR)

1.8 (1.3–2.4)

1.6 (1.3–2.0)

1.9 (1.2–2.9)

0.42

Angiotensin II/ Angiotensin 1–7 ratio, median (IQR)

1.6 (0.96–1.92)

1.66 (0.97–2)

1.58 (0.71–1.72)

0.39

  1. SAPS II, Simplified Acute Physiologic Score Two; SOFA, Sequential Organ Failure Assessment; PaO2, arterial partial pressure of oxygen; FiO2, Fraction of inspired oxygen; ICU, intensive care unit; ACEi, angiotensin converting enzyme inhibitor; ARBs, angiotensin II receptor blockers; ARDS, acute respiratory distress syndrome; HFNC, high-flow nasal cannula oxygen therapy; NIV, noninvasive mechanical ventilation; IMV, invasive mechanical ventilation; LoS, length of stay; AKI, Acute kidney injury; RAS, renin–angiotensin system; IQR, interquartile range; N, number of patients
  2. (‡)Seven out of 11 patients who were on chronic treatment with ACEi/ARBs discontinued these medications during hospitalization. The median time from withdrawal of these agents to study inclusion was 6 days [IQR: 4–7]
  3. †Acute respiratory distress syndrome was defined according to Berlin criteria (2012)
  4. ††Acute kidney injury was defined according to KDIGO criteria (2012)
  5. *healthy reference ranges: Renin 1.5–20 pg/ml; Angiotensin I (median 42 pg/ml [IQR:30.46–87.34]); Angiotensin II 25.1 ± 5.2 pg/ml; Angiotensin (1–7) 21.0 ± 4.1 pg/ml
  6. Direct plasma renin levels were determined by chemiluminescent immunoassay. Angiotensin compounds were measured by ELISA assay (Fine Biotech Co., Ltd)
  7. **Angiotensin 1–7 plasmatic levels were lower in patients who received IMV compared with those who never received IMV (214 pg/ml [IQR: 163–298] and 335 pg/ml [IQR: 259–499], respectively, p = 0.01)
  8. P values were calculated by Mann–Whitney test, Chi-square test and Fisher exact test, as appropriate, with a significance level of .05. All statistical analyses were performed using SAS 9.4 software (SAS Institute Inc, Cary, NC, USA)
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Critical Care

ISSN: 1364-8535