ACE-inhibitor therapy and survival among patients with multiorgan dysfunction syndrome (MODS) of cardiac and non-cardiac origin
| Autor: | Hendrik Schmidt, Mathias Rauchhaus, Kuno Hottenrott, Dirk Hoyer, Justin M. Carter, Karl Werdan, Ursula Müller-Werdan, Michael Buerke, R. Hennen, Roland Prondzinsky, Axel Schlitt |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Multiple Organ Failure Shock Cardiogenic Angiotensin-Converting Enzyme Inhibitors Autonomic Nervous System Coronary artery disease Sepsis Internal medicine medicine Humans cardiovascular diseases APACHE Retrospective Studies business.industry Cardiogenic shock Retrospective cohort study Middle Aged medicine.disease Survival Analysis Blood pressure Heart failure ACE inhibitor Cardiology Female Cardiology and Cardiovascular Medicine Multiple organ dysfunction syndrome business medicine.drug |
| Zdroj: | International journal of cardiology. 140(3) |
| ISSN: | 1874-1754 |
| Popis: | The multiple organ dysfunction syndrome (MODS) is the sequential failure of organ systems after a trigger event (e.g. cardiogenic shock) with a high mortality. ACE-inhibitors [ACEI] are known to ameliorate depressed autonomic function (heart rate variability [HRV]) to improve endothelial function and to decrease blood pressure. Modifications of these targets reduce major adverse cardiovascular events (patients with arterial hypertension, coronary artery disease and chronic heart failure). Our study aimed to characterize potential benefits of ACEI therapy in MODS patients.178 score-defined consecutive patients were enrolled. Inclusion criterion was an APACHE II scoreor=20 at admission to the ICU. Patients were evaluated for ACEI therapy and followed for 28, 180 and 365 days. HRV was calculated according to the international standards.68 patients received an ACEI during their ICU stay whereas 110 did not. The 28-day mortality was 55% (no ACEI treatment) vs. 22% (ACEI treatment, p0.0001) and the 1-year mortality accounted for 75% (no ACEI) vs. 50% (ACEI), p0.0001. There was no significant survival difference between early and later application of ACEI (after day 4), both application modes were characterized by an improved survival. MODS patients with ACEI treatment at admission had a better preserved HRV.Our results may suggest that MODS patients with ACEI treatment may have lower short- and longer-term mortality. HRV was less attenuated when patients received ACEI therapy at admission. Consequently, effectiveness of ACEI therapy should be validated in a prospective trial. |
| Databáze: | OpenAIRE |
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