Prior use of ACEIs/ARBs before medical ICU admission was associated with significantly lower in-hospital mortality compared to non-use (OR 0.51; 95% CI 0.32-0.79; p<0.01).
Cohort (n=693)
No
Does ACEI/ARB use prior to ICU admission reduce in-hospital mortality in adult patients admitted to the medical ICU?
Prior use of ACE inhibitors or ARBs is associated with reduced in-hospital mortality among adult patients admitted to the medical ICU.
Effect estimate: OR 0.51 (95% CI 0.32-0.79)
p-value: p=<0.01
BACKGROUND: The aim of this study was to evaluate whether angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) use prior to medical intensive care unit (ICU) admission was associated with in-hospital mortality and length of ICU stay. METHODS: A propensity score-matched cohort study was conducted at single center from 2004 to 2016. We included all adult patients who were admitted to the ICU due to internal medicine-related conditions. We compared patients who had used ACEIs/ARBs prior to ICU admission to patients who had not. Our primary and secondary outcomes were in-hospital mortality and length of stay among survivors and the deceased. Propensity scores were calculated via logistic regression analyses with forward stepwise selection. An odds ratio (OR) for primary outcome was calculated via logistic regression. Sensitivity analyses were performed using conditional logistic regression models including different sets of covariates to confirm our results. RESULTS: 3095 patients were admitted to the ICU. Overall, 693 patients were identified via matching, 231 of whom had used ACEIs/ARBs and 462 of whom had not. None of the baseline characteristics differed significantly between groups. Among them, 131 (18.9%) died. Those who had used ACEIs/ARBs had a lower rate of mortality (p < 0.01). Length of ICU stay did not differ significantly between those with ACEIs/ARBs and those without among survivors (p = 0.43) and the deceased (p = 0.14). The OR for mortality was 0.51 (95% confidence interval 0.32-0.79). The results of the sensitivity analyses confirmed the results (ORs 0.4 6-0.53; all were statistically significant). CONCLUSION: Prior ACEI/ARB use may be related to in-hospital mortality among medical ICU patients.
Kobayashi et al. (Mon,) conducted a cohort in Internal medicine-related conditions requiring ICU admission (n=693). Angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) vs. No prior ACEI/ARB use was evaluated on In-hospital mortality (OR 0.51, 95% CI 0.32-0.79, p=<0.01). Prior use of ACEIs/ARBs before medical ICU admission was associated with significantly lower in-hospital mortality compared to non-use (OR 0.51; 95% CI 0.32-0.79; p<0.01).
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