Treatment with ACE-inhibitors is associated with less severe disease with SARS-Covid-19 infection in a multi-site UK acute Hospital Trust

Daniel Bean; Zeljko Kraljevic; Thomas Searle; Rebecca Bendayan; Andrew Pickles; Amos Folarin; Lukasz Roguski; Kawsar Noor; Anthony Shek; Kevin o'gallagher; Rosita Zakeri; Ajay Shah; James Teo; Richard JB Dobson

Statistical Analysis: In order to investigate the association between ACEi and disease severity measured as critical care admission or death, we performed a series of logistic regressions applying Firth's correction. 13 This procedure has shown to be robust for low prevalence events and low-dimensional settings. 14, 15 In a first step, we explored independently the association for ACEi (Baseline model). In a second step, we adjusted the model for age and sex (Model 1). Then, we additionally adjusted for hypertension (Model 2), and additionally adjusted by other comorbidities diabetes and ischemic heart disease or heart failure (Model 3). We also explored the independent association for hypertension following the same modelling approach. Sensitivity analyses were performed i) using exact logistic regression with models adjusted variable by variable; ii) requiring at least two detections of medication for positive exposure; iii) using only structured data on in-hospital medication orders; iv) ignoring our 7 day window for medications; v) testing sensitivity to unmeasured confounders.