Effects of Renin‐Angiotensin–Aldosterone System Inhibitors on Long‐Term Major Adverse Cardiovascular Events in Sepsis Survivors
| Autor: | Yuan-Yi Chia, Yu-Chi Huang, Yuan Lo, Yi-Jung Lee, Chen-Hsiu Chen, Shu-Yu Ou, Yu-Ting Kuo |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Inotrope medicine.medical_specialty Angiotensin-Converting Enzyme Inhibitors Sepsis sepsis Young Adult Internal medicine Epidemiology medicine Humans Diseases of the circulatory (Cardiovascular) system Survivors Myocardial infarction major adverse cardiac events business.industry Hazard ratio medicine.disease all‐cause mortality Treatment Outcome Cardiovascular Diseases Heart failure RC666-701 Propensity score matching epidemiology renin‐angiotensin‐aldosterone system inhibitors Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 23 (2021) |
| ISSN: | 2047-9980 |
| DOI: | 10.1161/JAHA.121.022870 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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