Department of Anesthesiology Kaohsiung Veterans General Hospital Kaohsiung Taiwan.
Division of Neurology Department of Medicine Taipei City Hospital, Ren-Ai Branch Taipei Taiwan.
J Am Heart Assoc. 2021 Dec 7;10(23):e022870. doi: 10.1161/JAHA.121.022870. Epub 2021 Nov 30.
Background Sepsis is known to increase morbidity and duration of hospital stay and is a common cause of mortality worldwide. Renin-angiotensin-aldosterone system inhibitors (RAASis) are commonly used to treat hypertension but are usually discontinued during hospitalization for sepsis because of concerns about renal hypoperfusion. The aim of our study was to investigate whether RAASis should be continued after discharge in sepsis survivors and to identify the effects on the clinical outcomes. Methods and Results A total of 9188 sepsis survivors aged 20 years and older who were discharged from January 1, 2012 to December 31, 2019 were included in our analyses. We further divided sepsis survivors into RAASi users and nonusers. These groups were matched by propensity scores before the outcomes of interest, including all-cause mortality and major adverse cardiac events (MACE), were examined. After propensity score matching, 3106 RAASi users and 3106 RAASi nonusers were included in our analyses. Compared with RAASi nonusers, RAASi users had lower risks of all-cause mortality (hazard ratio [HR], 0.68; 95% CI, 0.62-0.75), MACEs (HR, 0.87; 95% CI, 0.81-0.94), ischemic stroke (HR, 0.85; 95% CI, 0.76-0.96), myocardial infarction (HR, 0.74; 95% CI, 0.61-0.90), and hospitalization for heart failure (HR, 0.84; 95% CI, 0.77-0.92). Subgroup analyses stratified by admission to the ICU and the use of inotropes showed similar results. Conclusions In our study, we found that RAASi users had reduced risks of all-cause mortality and MACEs. These findings suggested a beneficial effect of RAASi use by sepsis survivors after discharge.
败血症会增加发病率和住院时间，并成为全球范围内的常见死亡原因。肾素-血管紧张素-醛固酮系统抑制剂（RAASi）常用于治疗高血压，但由于担心肾脏灌注不足，通常在败血症住院期间停用。我们的研究目的是探讨败血症幸存者出院后是否应继续使用 RAASi，并确定其对临床结局的影响。
本研究共纳入了 9188 名年龄在 20 岁及以上的败血症幸存者，他们于 2012 年 1 月 1 日至 2019 年 12 月 31 日出院。我们进一步将败血症幸存者分为 RAASi 使用者和非使用者。在研究感兴趣的结局（包括全因死亡率和主要不良心脏事件[MACE]）之前，通过倾向评分匹配将这些组进行匹配。在倾向评分匹配后，纳入了 3106 名 RAASi 使用者和 3106 名 RAASi 非使用者。与 RAASi 非使用者相比，RAASi 使用者的全因死亡率（风险比[HR]，0.68；95%置信区间[CI]，0.62-0.75）、MACE（HR，0.87；95% CI，0.81-0.94）、缺血性卒中（HR，0.85；95% CI，0.76-0.96）、心肌梗死（HR，0.74；95% CI，0.61-0.90）和心力衰竭住院（HR，0.84；95% CI，0.77-0.92）的风险均降低。按 ICU 入院和使用正性肌力药进行亚组分析，结果相似。
在本研究中，我们发现 RAASi 使用者全因死亡率和 MACE 的风险降低。这些发现表明败血症幸存者出院后使用 RAASi 具有有益的效果。
