Effect of Angiotensin-Converting Enzyme Inhibitors, Angiotensin II Receptor Blockers, and Statins on Sepsis-Related Outcomes

Abstract

Objectives: Inhibitors of the renin-angiotensin system, namely, angiotensinconverting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB), and HMG-CoA reductase inhibitors, statins, have been reported to have anti-inflammatory effects. This study is to assess the association of ACEI, ARB, and statin with sepsis-related outcomes. MethOds: A retrospective cohort study was conducted using the Health Insurance Review and Assessment Service (HIRA) claims data. In adult patients hospitalized with sepsis in 2012, those who took ARB, ACEI, or statin 30 days before admission were identified. The outcomes were in-hospital death and length of stay (LOS) and the logistic regression and generalized linear model were carried out to examine the relation between the prior use of medication and the outcomes. Results: A total of 27,365 sepsis patients were included in the analysis, where the number of patients taking ACEI, ARB, or statin prior to sepsis hospitalization were 1,207 (4.41%), 3,951 (14.44%), and 2,473 (9.04%), respectively. After adjusting for age, sex, characteristics of hospitalization, and comorbidities, prior use of ACEI (Odds Ratio (OR) 0.752, 95% Confidence Interval (CI): 0.661-0.855), ARB (OR 0.575, 95% CI: 0.532-0.621), or statin (OR 0.716, 95% CI: 0.651-0.788) were significantly associated with decreased in-hospital mortality. Although the treatment of ACEI, ARB, or statin before admission were related to increased LOS, prior use of ARB was only associated with increased LOS after excluding death cases (OR 1.24, 95% CI: 1.16-1.32). cOnclusiOns: Use of ACEI, ARB, or statin before hospitalization appeared to be associated with decreased mortality in sepsis patients. Further prospective randomized control trials are needed to evaluate the beneficial effect of ACEI, ARB, and statin in sepsis.