Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.
Korean J Intern Med. 2021 Mar;36(2):371-381. doi: 10.3904/kjim.2019.262. Epub 2020 Apr 9.
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.
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.
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.
Pre-hospitalization use of ACE inhibitors or ARBs for sepsis was an independent factor for a lower rate of in-hospital mortality.
背景/目的：肾素-血管紧张素系统抑制剂、血管紧张素转换酶（ACE）抑制剂和血管紧张素 II 受体阻滞剂（ARB）据称具有抗炎作用。本研究评估了 ACE 抑制剂和 ARB 的先前使用与脓毒症相关临床结局的关系。
采用健康保险审查和评估服务索赔数据进行基于人群的观察性研究。在 2012 年新发生脓毒症住院的成年患者中，分析了至少在住院前 30 天服用 ARB 或 ACE 抑制剂的患者。使用广义线性模型和逻辑回归检查药物使用与临床结局（如住院死亡率、机械通气和住院时间）之间的关系。
在总共 27628 名因脓毒症住院的患者中，ACE 抑制剂、ARB 和非使用者组分别包括 1214 例（4.4%）、3951 例（14.4%）和 22463 例（82.1%）患者。由于 ACE 抑制剂和 ARB 组的患者有多种合并症，因此观察到更高的重症监护病房入院、血液透析和机械通气率。然而，在调整混杂因素后，ACE 抑制剂（比值比 [OR]，0.752；95%置信区间 [CI]，0.661 至 0.855）或 ARB（OR，0.575；95% CI，0.532 至 0.621）的使用与住院死亡率降低显著相关。
脓毒症患者住院前使用 ACE 抑制剂或 ARB 是降低住院死亡率的独立因素。
