Key result
Prior ARB exposure linked to ~38% lower in-ICU mortality in critically ill cancer patients.
Why the study?
Activation of the renin-angiotensin system promotes tumorigenesis and renin-angiotensin system blockers may benefit survival in solid cancers, but their impact in critically ill cancer patients required evaluation.
Do renin-angiotensin system blockers improve in-ICU and one-year survival in critically ill patients with solid cancers?
Cohort (n=1,845)
No
Do renin-angiotensin system blockers improve in-ICU and one-year survival in critically ill patients with solid cancers?
The use of renin-angiotensin system blockers, particularly ARBs, is associated with improved short- and long-term survival in critically ill patients with solid cancers.
Answers are grounded in this paper and cite their sources.
ARB exposure was associated with better survival in this population; hypothesis-generating and should not yet change practice.
Increasing evidence argues for the promotion of tumorigenesis through activation of the renin-angiotensin system pathway. Accordingly, a benefit of renin-angiotensin system blockers (RABs) treatments has been suggested in patients with solid cancers in terms of survival. We aimed to evaluate in-ICU survival and one-year survival in cancer patients admitted to the ICU with respect to the use of RABs. We conducted a retrospective observational single-center study in a 24-bed medical ICU. We included all solid cancer patients (age ≥ 18 years) requiring unplanned ICU admission. From 2007 to 2020, 1845 patients with solid malignancies were admitted (median age 67 years (59–75), males 61.7%). The most frequent primary tumor sites were the gastrointestinal tract (26.8%), the lung (24.7%), the urological tract (20.1%), and gynecologic and breast cancers (13.9%). RABs were used in 414 patients, distributed into 220 (53.1%) with angiotensin-receptor blockers (ARBs) and 194 (46.9%) with angiotensin-converting enzyme inhibitors (ACEis). After multivariate adjustment, ARBs use (OR = 0.62, 95%CI (0.40–0.92), p = 0.03) and ACEis use (OR = 0.52, 95%CI (0.32–0.82), p = 0.006) were both associated with improved in-ICU survival. Treatment with ARBs was independently associated with decreased one-year mortality (OR = 0.6, 95%CI (0.4–0.9), p = 0.02), whereas treatment with ACEis was not. In conclusion, this study argues for a beneficial impact of RABs use on the prognosis of critically ill cancer patients.
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Laghlam et al. (2023) conducted a cohort in Solid malignancies requiring unplanned ICU admission (n=1,845). Renin-angiotensin system blockers (ARBs or ACEis) vs. No renin-angiotensin system blockers was evaluated on In-ICU survival (OR 0.62, 95% CI 0.40-0.92, p=0.03). Prior exposure to angiotensin-receptor blockers was associated with improved in-ICU survival (OR 0.62) and decreased one-year mortality (OR 0.6) in critically ill patients with solid malignancies.
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