A Retrospective Cohort Study: Unveiling the Association between Pre - ICU Use of Angiotensin - converting Enzyme Inhibitors and Angiotensin II Receptor Blockers and Mortality in Septic Patients

Background/Aims : Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) possess anti-inflammatory properties. The purpose of this study was to find out what impact the use of ACEIs and ARBs before ICU admission has on the clinical conditions of patients with sepsis. Methods Patients diagnosed with sepsis were included in this study using data extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The primary endpoints assessed were the 30- and 90-day mortality rates, along with the length of stay in the intensive care unit (ICU). Statistical analysis was conducted using multivariable Cox regression and linear regression models, while propensity score matching (PSM) was used to ensure the reliability and validity of the results. Results Among the 22,783 patients hospitalized for sepsis. Multivariable Cox regression analysis revealed that the utilization of ACEIs/ARBs was significantly associated with a notable reduction in 90 - day mortality (hazard ratio (HR) = 0.36, 95% confidence interval: 0.33–0.4, p < 0.001). Regarding safety considerations, the use of ACEIs/ARBs was associated with an increased risk of acute kidney injury (AKI) (Odds Ratio (OR) = 1.09, 95% CI: 1.01–1.17, p = 0.026) and a higher incidence of vasopressor drug use (OR = 1.11, 95% CI: 1.04–1.19, p = 0.002). However, ACEIs/ARBs were linked with a reduced need for continuous renal replacement therapy (OR = 0.77, 95% CI: 0.66–0.9, p = 0.001). Conclusions The pre - ICU administration of ACEIs/ARBs to patients with sepsis may be associated with lower mortality rates.