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.