Bocquet Alexis, Marmion Nicolas, Boccon-Gibod Isabelle, Bouillet Laurence
Internal Medicine Department, National Reference Center for Angioedema/CREAK, Univ. Grenoble Alpes/CHU Grenoble Alpes, Grenoble, France.
Allergology Department/ CREAK, CHU Saint Pierre, Réunion, France.
World Allergy Organ J. 2025 Mar 12;18(3):101037. doi: 10.1016/j.waojou.2025.101037. eCollection 2025 Mar.
Angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema (AE-ACEI) may be life-threatening, and the treatment should therefore be discontinued. However, patients taking ACEI may also have mast cell-mediated angioedema (AE-MC). Differentiating between AE-ACEI and AE-MC in patients taking ACEI is sometimes difficult. We propose to identify the factors associated with the diagnosis of AE-ACEI in patients.
A multicenter retrospective study was carried out at Grenoble Alpes University Hospital and University Hospital of La Réunion. All patients referred for suspected diagnosis of AE-ACEI were included in the study between January 2019 and January 2022. The final diagnosis was made by the expert physician after a minimum follow-up of 1 year and after a biological work-up ruling other bradykinin-mediated angioedema.
A total of 93 patients were analyzed, 49 with a final diagnosis of AE-ACEI and 44 with a diagnosis of AE-MC. Multivariate analysis identified 4 factors associated with the final diagnosis of AE-ACEI: number of AE between the introduction of ACEI and the consultation ≤3 (OR: 7.93 [1.60-50.7], p = 0.017) (1 point), duration of AE strictly greater than 24 h regardless of the treatments administered (OR: 8.41[2.07-44.5], p < 0.01) (1 point), hospitalization in intensive care unit (OR: 7.14[1.19-50.0], p = 0.045) (1 point) and no recurrence of AE after stopping ACEI, regardless of the delay (OR: 16.7[3.37-125], p < 0.01) (2 points).This five-point diagnostic score (AUC: 0.85 [0.75-0.95]) identifies patients with a low probability of AE-ACEI when the score is 0-2 (sensitivity: 0.93, specificity: 0.35) and a high probability when it is between 4 and 5 (sensitivity: 0.53, specificity: 0.97).
After a consultation in an angioedema expert center, the diagnosis of AE-ACEI has been excluded in almost half the patients. We identified a five-point score that could help in the diagnosis of AE-ACEI and in the decision to contraindicate the use of ACE inhibitors for life.
血管紧张素转换酶抑制剂（ACEI）诱发的血管性水肿（AE-ACEI）可能危及生命，因此应停用该治疗。然而，服用ACEI的患者也可能发生肥大细胞介导的血管性水肿（AE-MC）。在服用ACEI的患者中区分AE-ACEI和AE-MC有时很困难。我们旨在确定与患者AE-ACEI诊断相关的因素。
在格勒诺布尔阿尔卑斯大学医院和留尼汪大学医院进行了一项多中心回顾性研究。2019年1月至2022年1月期间，所有因疑似AE-ACEI诊断而转诊的患者均纳入本研究。最终诊断由专家医师在至少1年的随访以及排除其他缓激肽介导的血管性水肿的生物学检查后做出。
共分析了93例患者，其中49例最终诊断为AE-ACEI，44例诊断为AE-MC。多因素分析确定了与AE-ACEI最终诊断相关的4个因素：ACEI引入至会诊期间AE的次数≤3次（比值比：7.93[1.60 - 50.7]，p = 0.017）（1分），无论给予何种治疗，AE持续时间严格大于24小时（比值比：8.41[2.07 - 44.5]，p < 0.01）（1分），入住重症监护病房（比值比：7.14[1.19 - 50.0]，p = 0.045）（1分）以及停用ACEI后AE无复发，无论间隔时间多久（比值比：16.7[3.37 - 125]，p < 0.01）（2分）。这个五分诊断评分（曲线下面积：0.85[0.75 - 0.95]）在评分0 - 2分时可识别AE-ACEI可能性低的患者（敏感性：0.93，特异性：0.35），在评分4 - 5分时可识别可能性高的患者（敏感性：0.53，特异性：0.97）。
在血管性水肿专家中心会诊后，几乎一半患者被排除AE-ACEI诊断。我们确定了一个五分评分，可有助于AE-ACEI的诊断以及决定终身禁用ACE抑制剂。
