Key result
Prior ACEi or ARB use is linked to ~25% lower in-hospital mortality in new-onset sepsis.
Why the study?
Inhibitors of the renin-angiotensin system reportedly have anti-inflammatory effects, leading investigators to assess the association of prior ACE inhibitor or ARB use with sepsis-related clinical outcomes.
Does prior use of ACE inhibitors or ARBs reduce in-hospital mortality in adult patients hospitalized with sepsis?
Cohort (n=27,628)
Does prior use of ACE inhibitors or ARBs reduce in-hospital mortality in adult patients hospitalized with sepsis?
Odds Ratio: 0.752 (95% CI 0.661–0.855)
Absolute Event Rate: 33.39% vs 41.74%
p-value: p=<0.001
Pre-hospitalization use of ACE inhibitors or ARBs is independently associated with lower in-hospital mortality in patients admitted with sepsis.
May support pre-hospital ACEI/ARB use in sepsis; hypothesis-generating and requires RCTs before practice change.
BACKGROUND/AIMS: Inhibitors of the renin-angiotensin system, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), reportedly have anti-inflammatory effects. This study assessed the association of prior use of ACE inhibitors and ARBs with sepsis-related clinical outcomes. METHODS: A population-based observational study was conducted using the Health Insurance Review and Assessment Service claims data. Among the adult patients hospitalized with new onset of sepsis in 2012, patients who took ARBs or ACE inhibitors at least 30 days prior to hospitalization were analyzed. Generalized linear models and logistic regression were used to examine the relation between the prior use of medication and clinical outcomes, such as in-hospital mortality, mechanical ventilation, and length of stay. RESULTS: Of a total of 27,628 patients who were hospitalized for sepsis, the ACE inhibitor, ARB, and non-user groups included 1,214 (4.4%), 3,951 (14.4%), and 22,463 (82.1%) patients, respectively. As the patients in the ACE inhibitor and ARB groups had several comorbid conditions, higher rates of intensive care unit admission, hemodialysis, and mechanical ventilation were observed. However, after covariate adjustment, the use of ACE inhibitor (odds ratio [OR], 0.752; 95% confidence interval [CI], 0.661 to 0.855) or ARB (OR, 0.575; 95% CI, 0.532 to 0.621) was significantly associated with a lower rate of in-hospital mortality. CONCLUSION: Pre-hospitalization use of ACE inhibitors or ARBs for sepsis was an independent factor for a lower rate of in-hospital mortality.
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Lee et al. (2020) conducted a cohort in Sepsis (n=27,628). ACE inhibitors or ARBs vs. Non-users was evaluated on In-hospital mortality (OR 0.752, 95% CI 0.661-0.855, p=<0.001). Pre-hospitalization use of ACE inhibitors or ARBs was independently associated with a lower rate of in-hospital mortality (OR 0.752 and OR 0.575, respectively) in patients with new-onset sepsis.
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