Correlation between anti-hypertensive drugs and disease progression among moderate, severe, and critically ill COVID-19 patients in the second referral hospital in Surabaya: A retrospective cohort study [version 2; peer review: 2 approved]

Background: Hypertension, as the comorbidity accompanying COVID-19, is related to angiotensin-converting enzyme 2 receptor (ACE-2R) and endothelial dysregulation which have an important role in blood pressure regulation. Other anti-hypertensive agents are believed to trigger the hyperinflammation process. We aimed to figure out the association between the use of anti-hypertensive drugs and the disease progression of COVID-19 patients. Methods: This study is an observational cohort study among COVID-19 adult patients from moderate to critically ill admitted to Universitas Airlangga Hospital (UAH) Surabaya with history of hypertension and receiving anti-hypertensive drugs. Results: Patients receiving beta blockers only had a longer length of stay than angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ACEI/ARB) or calcium channel blockers alone (17, 13.36, and 13.73 respectively), had the higher rate of intensive care unit (ICU) admission than ACEi/ARB (p 0.04), and had the highest mortality rate (54.55%). There were no significant differences in length of stay, ICU admission, mortality rate, and days of death among the single, double, and triple anti-hypertensive groups. The mortality rate in groups taking ACEi/ARB was lower than other combination. Conclusions: Hypertension can increase the severity of COVID-19. The use of ACEI/ARBs in ACE-2 receptor regulation which is thought to aggravate the condition of COVID-19 patients has not yet been proven. This is consistent with findings in other anti-hypertensive groups

Correlation between anti-hypertensive drugs and disease progression among moderate, severe, and critically ill COVID-19 patients in the second referral hospital in Surbaya: A retrospective cohort study

Background: Hypertension, as the comorbidity accompanying COVID-19, is related to angiotensin-converting enzyme 2 receptor (ACE-2R) and endothelial dysregulation which have an important role in blood pressure regulation. Other anti-hypertensive agents are believed to trigger the hyperinflammation process. We aimed to figure out the association between the use of anti-hypertensive drugs and the disease progression of COVID-19 patients. Methods: This study is an observational cohort study among COVID-19 adult patients from moderate to critically ill admitted to Universitas Airlangga Hospital (UAH) Surabaya with history of hypertension and receiving anti-hypertensive drugs. Results: Patients receiving beta blockers only had a longer length of stay than angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ACEI/ARB) or calcium channel blockers alone (17, 13.36, and 13.73 respectively), had the higher rate of intensive care unit (ICU) admission than ACEi/ARB (p 0.04), and had the highest mortality rate (54.55%). There were no significant differences in length of stay, ICU admission, mortality rate, and days of death among the single, double, and triple anti-hypertensive groups. The mortality rate in groups taking ACEi/ARB was lower than other combination. Conclusions: Hypertension can increase the severity of COVID-19. The use of ACEI/ARBs in ACE-2 receptor regulation which is thought to aggravate the condition of COVID-19 patients has not yet been proven. This is consistent with findings in other anti-hypertensive groups

The role of oxidative stress markers in Indonesian chronic kidney disease patients: a cross sectional study

Background: Several aspects of chronic kidney disease (CKD) such as the incidence rate and mortality rate are concerning. Oxidative stress contributes to progression and mortality in patients with CKD; however, a specific correlation between several markers of oxidative stress and the estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in the Indonesian population has not been sufficiently described yet. Methods: This study was an analytic observational study with a sample of 56 patients with CKD in Universitas Airlangga Hospital, Surabaya, Indonesia, from December 2019 – March 2020. The markers for oxidative stress investigated were urinary 8-hydroxy-2 deoxyguanosine (8-OHdG), serum symmetric dimethylarginine (SDMA) and asymmetric dimethylarginine (ADMA). The correlations between each variable of oxidative stress and CKD were analyzed using Pearson analysis. Results: There was a positive correlation between 8-OHdG and eGFR (p=0.00, r=0.51); however, there was a negative correlation between 8-OHdG and ACR (p=0.025, r=-0.30). SDMA and eGFR showed a negative correlation (p=0.00, r=-0.648), while SDMA and ACR showed a positive correlation (p=0.03, r=0.349). ADMA showed a negative correlation with eGFR (p=0.00, r=-0.476). There were significantly decreased 8-OHdG but increased ADMA and SDMA as the CKD stage progressed (p=0.001, p=0.00, and p = 0.00, respectively). Higher urine 8-OHdG was detected in patients without history of hemodialysis, whereas ADMA and SDMA showed higher value in patients with hemodialysis (p=0.00, p=0.00, and p=0.004, respectively), patients with history of diabetes mellitus (DM) had higher mean 8-OHdG (p 0.000) yet lower serum ADMA and SDMA (p=0.004 and p=0.003, respectively). Conclusions: In patients with CKD in Indonesia, the markers for oxidative stress 8-OHdG, SDMA, and ADMA are correlated with eGFR and ACR levels. There were also significant difference in 8-OHdG, SDMA, and ADMA levels among CKD stages, between dialysis vs non dialysis, and DM vs non DM patients

High-dose vs low-dose steroid in pregnancy patients with systemic lupus erythematosus and lupus nephritis: A systematic review and meta-analysis

Background: Management of systemic lupus erythematosus (SLE) and lupus nephritis (LN) in pregnancy has been improving in recent decades. However, SLE can still lead to adverse pregnancy outcomes if not appropriately treated. Optimal dose of steroids, as one of the most commonly used for the treatment of SLE and LN in pregnancy is still a subject of debate. In this review, we determine the pregnancy outcomes in SLE and LN patients treated with low vs high doses of steroids. Methods: ProQuest, Pubmed, Science Direct, Scopus, and Web of Science were carefully searched for relevant studies published in English. A total of 2,596 studies were reviewed. We extracted the data from previous studies showing the use of steroids treatment in high-dose and low-dose related to pregnancy outcomes. We provide larger data about maternal (preterm rupture of membrane, fetal loss, pre-eclampsia, and flare up) and fetal outcomes (prematurity, small gestational age, low birth weight) receiving high vs low steroid in patients with SLE and LN in this systematic review and meta-analysis. Results: A total of 13 studies were included. Of these, one study discussed a group with LN and 12 other studies discussed SLE with related maternal and fetal outcomes. Maternal outcome in the group with low-dose steroid showed a lower risk of fetal loss (odds ratio (OR): 1.93; 95% confidence interval (CI) 1.01-3.70), but there were no differences in other maternal outcomes. The low-dose steroid group showed a better fetal outcome, with a lower risk of prematurity (OR: 3.06; 95% CI 1.98-4.71), small gestational age (OR: 2.63; 95% CI 1.15-6.00), and low birth weight (OR: 2.43; 95% CI 1.23-4.79). Conclusions: In pregnant patients with SLE or LN, high-dose steroids are associated with the high risk of fetal loss during pregnancy, preterm birth, small gestational age, and low birth weight