ArticleFrontiers in pharmacology2026
Combined ACEI and ARB therapy and ICU mortality in critically ill COVID-19 patients: a retrospective cohort study.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Corrections and comments
- Erratum issued
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7 authors.
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Abstract
Introduction: The clinical safety and potential benefits of renin-angiotensin-aldosterone system (RAAS) inhibitors in COVID-19 remain debated, particularly in critically ill populations. Evidence on combined angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) therapy is limited, and the potential interaction with acid-base status has not been sufficiently explored. Methods: We conducted a retrospective cohort study including adults with PCR-confirmed COVID-19 admitted to the intensive care unit (ICU) at Hospital Dr. Gustavo Fricke (Chile) between March 2020 and December 2021. Patients were categorized according to RAAS therapy at admission (none, ACEI only, ARB only, ACEI + ARB) and arterial bicarbonate (HCO Results: Of 2,838 hospitalized patients, 671 required ICU admission and 655 had complete data for analysis. Overall ICU mortality was 34.2%. Combined ACEI + ARB therapy was associated with lower mortality (16.9%) compared with no RAAS blockade (38.3%; p < 0.05), whereas ACEI or ARB monotherapy showed no significant association. Among patients with low or normal admission HCO Discussion: In this observational ICU cohort, dual RAAS blockade was associated with lower in-hospital mortality, although causal inference is limited by the retrospective design and incomplete pharmacologic exposure data. Early bicarbonate increase may reflect renal adaptive capacity and has potential prognostic value. Prospective controlled studies are needed to clarify the clinical relevance of RAAS modulation and metabolic biomarkers in severe COVID-19.
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