Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Investigating Non-Suicidal Self-Injury in Justice-Involved Adolescents Using the Short-Term Assessment of Risk and Treatability: Adolescent Version (Start-AV)

Abstract not availabl

Patterns of Aggression and Non-Suicidal Self-Injury in At-Risk Adolescents: Examining the Roles of Emotion Dysregulation and Perceived Social Support

This study used a person-centered approach to investigate the association between non-suicidal self-injury (NSSI) and the forms and functions of aggression in a clinical sample of adolescents. The study also assessed the potential moderating roles that emotion dysregulation and perceived social support may impact this association. The sample was comprised of 41 adolescents in an intensive outpatient mental health treatment program at the Mt. Sinai-St. Luke’s Comprehensive Adolescent Rehabilitation and Education Services (CARES) program. The study addressed gaps in the literature by extending prior research supporting an association between aggression and NSSI by simultaneously exploring moderating effects that may help clarify the underlying relationship using a person-centered approach for grouping aggression forms and functions. Two distinct groups of participants for both overt and relational aggression from the cluster analysis: one characterized by low reactive and low proactive aggression, and a second characterized by high reactive and high proactive aggression. However, these two groups were not association with self-reported NSSI endorsement in the previous year. Furthermore, emotion dysregulation and perceived social support did not moderate the association between NSSI and aggression. The small size of the sample may have prevented significant differences from emerging across the two aggression groups, and thus future research evaluating NSSI and forms and functions of aggression in clinical adolescent samples will benefit from larger overall sample sizes. The low rates of aggression endorsement across the sample may have prevented significant differences from emerging across the clusters. However, current findings do highlight the potential importance of assessing emotion dysregulation in assessment of aggression and NSSI, and the utility of identifying form and function of aggression in adolescents endorsing NSSI behavior

Suicide Risk, Self-Injury, and Sleep: An Exploration of the Associations in a Sample of Juvenile Justice Involved Adolescents

Court-involved youth living in the community represent a vulnerable, yet understudied, group that is at risk for a variety of concerning outcomes including increased suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). Additionally, sleep disruption, which has been associated with an increase in impulsive decision making, appears to be disproportionately high in this population. However, little is known about any connection between poor sleep and increased suicide risk and NSSI in a group of youth. This study explores the associations between sleep disruption, suicidal ideation, suicide attempts, and NSSI in a sample of court-involved youth in the community referred for mental health evaluation at a court-based mental health clinic. Findings suggest that sleep disruption is related to NSSI in this population but not suicidal ideation and suicide attempts. Additional relationships were found between NSSI and being female, as well as having a lifetime history of trauma and marijuana use. Findings suggest that court clinics may wish to screen for sleep disruption as a risk factor for NSSI, and future studies may wish to explore improved sleep as a protective factor for CINI youth

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc