Early administration of an ACEI/ARB within 72 hours of hospitalization was associated with a reduced risk of in-hospital mortality compared to nonusers (OR 0.64; 95% CI 0.53-0.77; P<.001).
Cohort (n=18,986)
Does early administration of an ACEI/ARB reduce in-hospital mortality in critically ill patients?
Early administration of ACEI/ARB within 72 hours of hospitalization in critically ill patients is associated with significantly reduced in-hospital and ICU mortality, regardless of baseline renal function.
Effect estimate: OR 0.64 (95% CI 0.53-0.77)
p-value: p=< .001
Renal dysfunction is associated with increased mortality and length of hospital stay in critically ill patients. However, it remains unclear whether the early administration of an angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) for intensive care unit patients with renal dysfunction is associated with reduced in-hospital mortality. We conducted a retrospective analysis of critically ill patients who received early administration of an ACEI/ARB within 72 hours after being hospitalized. Patients were selected from the Medical Information Mart for Intensive Care IV database. We included 18,986 critically ill patients in our analysis. After propensity score matching, our final study cohort of 4974 patients consisted of patients who received early administration of an ACEI/ARB (n = 2487) and nonusers (n = 2487). Results of logistic regression showed that early administration of an ACEI/ARB was associated with reduced risk of in-hospital mortality (odds ratio, 0.64; 95% confidence interval, 0.53-0.77; P < .001) and intensive care unit death (odds ratio, 0.56; 95% confidence interval, 0.45-0.70; P < .001) when compared to nonusers. There was no meaningful interaction for early administration of an ACEI/ARB versus nonusers across estimated glomerular filtration rate in outcomes. Sensitivity analysis showed there was no difference in the outcomes between early administration of ACEI and that of ARB. In this study, we found that early administration of an ACEI/ARB was associated with a reduced risk of in-hospital adverse outcomes based on renal function among critically ill patients. There was no interaction between early administration of an ACEI/ARB and in-hospital adverse outcomes across estimated glomerular filtration rate.
Zhang et al. (Thu,) conducted a cohort in critically ill patients (n=18,986). ACEI/ARB vs. nonusers was evaluated on in-hospital mortality (OR 0.64, 95% CI 0.53-0.77, p=< .001). Early administration of an ACEI/ARB within 72 hours of hospitalization was associated with a reduced risk of in-hospital mortality compared to nonusers (OR 0.64; 95% CI 0.53-0.77; P<.001).