Effect of Renin-Angiotensin-Aldosterone System Inhibitors on Short-Term Mortality After Sepsis A Population-Based Cohort Study
Effect of Renin-Angiotensin-Aldosterone System Inhibitors on Short-Term Mortality After Sepsis A Population-Based Cohort Study
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DOI：
10.1161/hypertensionaha.119.13197
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发表时间：
2020-02-01
期刊：
影响因子：
8.3
通讯作者：
Lee, Chien-Chang
中科院分区：
文献类型：
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作者：
Hsu, Wan-Ting;Galm, Brandon Patrick;Lee, Chien-Chang
肾素-血管紧张素-醛固酮系统（RAAS）的拮抗剂，包括ACEI（血管紧张素转换酶抑制剂）和ARB（血管紧张素II受体阻滞剂），可预防器官衰竭。因此，我们研究是否特异性RAAS抑制剂与降低败血症患者的死亡率相关，我们进行了一项基于人群的回顾性队列研究，采用基于多变量倾向评分的回归来控制使用不同RAAS抑制剂的患者之间的差异。采用多变量校正的考克斯比例风险回归模型确定RAAS抑制剂与脓毒症结局之间的相关性。为了直接比较ACEI使用者、ARB使用者和非使用者，进行了3向倾向评分匹配方法。通过随机效应荟萃分析将结果与先前的证据合并。共有52727例患者因脓毒症住院，其中7642例处方ACEI，4237例处方ARB。使用倾向评分匹配分析，与不使用相比，既往使用ACEI与30天死亡率（风险比，0.84 [95%CI，0.75-0.94]）和90天死亡率（风险比，0.83 [95%CI，0.75-0.92]）降低相关。既往ARB使用与90天生存率改善相关（风险比，0.88 [95% CI，0.83-0.94]）。这些结果在关注非癌症患者和高血压患者的敏感性分析中持续存在。相比之下，未发现既往β受体阻滞剂暴露的有益作用（风险比，0.99 [95% CI，0.94-1.05]）。从荟萃分析中获得的既往使用ACEI/ARB的合并估计值为0.71（95%CI，0.58-0.87）。在脓毒症发生时已经接受RAAS抑制剂治疗的患者中，脓毒症后的短期死亡率显著降低。
Antagonists of the renin-angiotensin-aldosterone system (RAAS), including ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers), may prevent organ failure. We, therefore, investigated whether specific RAAS inhibitors are associated with reduced mortality in patients with sepsis.We conducted a population-based retrospective cohort study using multivariable propensity score-based regression to control for differences among patients using different RAAS inhibitors. A multivariable-adjusted Cox proportional-hazards regression model was used to determine the association between RAAS inhibitors and sepsis outcomes. To directly compare ACEI users, ARB users, and nonusers, a 3-way propensity score matching approach was performed. Results were pooled with previous evidence via a random-effects meta-analysis. A total of 52 727 patients were hospitalized with sepsis, of whom 7642 were prescribed an ACEI and 4237 were prescribed an ARB. Using propensity score-matched analyses, prior ACEI use was associated with decreased 30-day mortality (hazard ratio, 0.84 [95% CI, 0.75-0.94]) and 90-day mortality (hazard ratio, 0.83 [95% CI, 0.75-0.92]) compared with nonuse. Prior ARB use was associated with an improved 90-day survival (hazard ratio, 0.88 [95% CI, 0.83-0.94]). These results persisted in sensitivity analyses focusing on patients without cancer and patients with hypertension. By contrast, no beneficial effect was found for antecedent beta-blockers exposure (hazard ratio, 0.99 [95% CI, 0.94-1.05]). The pooled estimates obtained from the meta-analysis was 0.71 (95% CI, 0.58-0.87) for prior use of ACEI/ARB.The short-term mortality after sepsis was substantially lower among those who were already established on RAAS inhibitor treatment when sepsis occurred.