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Angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use prior to medical intensive care unit admission and in-hospital mortality: propensity score-matched cohort study

  • Daiki KobayashiEmail author
  • Nagato Kuriyama
  • Fumitaka Yanase
  • Osamu Takahashi
  • Kazuhiro Aoki
  • Yasuhiro Komatsu
Original Article
  • 12 Downloads

Abstract

Background

The aim of this study was to evaluate whether angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) use prior to medical intensive care unit (ICU) admission was associated with in-hospital mortality and length of ICU stay.

Methods

A propensity score-matched cohort study was conducted at single center from 2004 to 2016. We included all adult patients who were admitted to the ICU due to internal medicine-related conditions. We compared patients who had used ACEIs/ARBs prior to ICU admission to patients who had not. Our primary and secondary outcomes were in-hospital mortality and length of stay among survivors and the deceased. Propensity scores were calculated via logistic regression analyses with forward stepwise selection. An odds ratio (OR) for primary outcome was calculated via logistic regression. Sensitivity analyses were performed using conditional logistic regression models including different sets of covariates to confirm our results.

Results

3095 patients were admitted to the ICU. Overall, 693 patients were identified via matching, 231 of whom had used ACEIs/ARBs and 462 of whom had not. None of the baseline characteristics differed significantly between groups. Among them, 131 (18.9%) died. Those who had used ACEIs/ARBs had a lower rate of mortality (p < 0.01). Length of ICU stay did not differ significantly between those with ACEIs/ARBs and those without among survivors (p = 0.43) and the deceased (p = 0.14). The OR for mortality was 0.51 (95% confidence interval 0.32–0.79). The results of the sensitivity analyses confirmed the results (ORs 0.4 6–0.53; all were statistically significant).

Conclusion

Prior ACEI/ARB use may be related to in-hospital mortality among medical ICU patients.

Keywords

Renin angiotensin-aldosterone system Length of stay Logistic regression 

Notes

Acknowledgements

The authors express sincere thanks to Ms. Aya Oizumi and Ms. Chika Horikawa for data extraction.

Compliance with ethical standards

Conflict of interest

All authors declared that there is no potential conflict of interest.

Ethical approval

Our article is an independent research work. This paper does not contain the results of any other published works by other researchers.

Informed consent

Because this study was retrospective study, the IRB at the hospital waived to obtain informed consent from patients. However, patients who declared not to be used their anonymized data in our study by viewing our public documents were excluded.

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Copyright information

© Italian Society of Nephrology 2019

Authors and Affiliations

  1. 1.Division of General Internal Medicine, Department of MedicineSt. Luke’s International HospitalTokyoJapan
  2. 2.Fujita Health UniversityToyoakeJapan
  3. 3.Department of Epidemiology for Community Health and MedicineKyoto Prefectural University of MedicineKyotoJapan
  4. 4.Department of Intensive Care UnitSaitama Medical Center Jichi Medical UniversityOmiyaJapan
  5. 5.Department of Anesthesia and Intensive Care UnitSt. Luke’s International HospitalTokyoJapan
  6. 6.Division of Nephrology, Department of MedicineSt. Luke’s International HospitalTokyoJapan

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