Effects of Renin‐Angiotensin–Aldosterone System Inhibitors on Long‐Term Major Adverse Cardiovascular Events in Sepsis Survivors

Abstract

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.

Long-term risk of death in patients with infection attended by prehospital emergency services

“…De otro lado, son pacientes con una carga de comorbilidad elevada (los no supervivientes presentaron un ICCa cercano a 5 puntos) y con una edad avanzada, lo que finalmente conformó una cohorte muy bien caracterizada, con un nivel de fragilidad muy elevado. Estos datos parecen confirmar que padecer una sepsis, aun sobreviviendo a la fase aguda, representa un factor de mal pronóstico, con incrementos de rehospitalizaciones, infección recurrente, deterioro cognitivo y eventos adversos cardiovasculares mayores y, en definitiva, aumentos de la mortalidad acumulada 3,4,18,19 . La actual pandemia por COVID-19 representó una disrupción a nivel global en los sistemas de salud, que afectó de forma especialmente intensa a los SEM y SUH, lugar de entrada de los pacientes al sistema.…”

“…El modelo incluyó variables epidemiológicas, analíticas y clínicas y, como era de esperar, la edad, el acúmulo de comorbilidades y la institucionalización se asociaron con una mayor mortalidad 14,15,22 . A nivel analítico, elevaciones de ácido láctico, creatinina, nitrógeno ureico en sangre, potasio y presión parcial de dióxido de carbono se asocian con peores resultados, y son factores que colaboran de forma activa en una ineficiente perfusión tisular, y condicionan el mal pronóstico de estos pacientes 13,[23][24][25] . Otras variable clínica introducida en el modelo final, y dentro del flujo de trabajo estándar del SEM, fue la saturación en relación con fracción inspirada de oxígeno, variable que forma parte de las escalas de disfunción multiorgánica como el SOFA o mSOFA y que gradúa el fallo del sistema respiratorio 1,26 1,00 (0,99-1,01) 0,007 0,004 1,670 0,094 IC: intervalo de confianza; pCO 2 : presión parcial de dióxido de carbono; ICCa: Índice de Comorbilidad de Charlson ajustado a la edad; SaFi: saturación en relación con fracción inspirada de oxígeno.…”

Cardiac dysfunction in survivors of sepsis: a scoping review

“…We could find no randomised controlled trials investigating interventions related to reducing risk of adverse cardiovascular events following sepsis, although three retrospective observational studies focused on cohorts of patients prescribed statins or renin-angiotensin-aldosterone (RAAS) inhibitors, drugs commonly used in management or prevention of cardiovascular disease, versus those who were not. [21][22][23]…”

Survival Benefit of Renin-Angiotensin System Blockers in Critically Ill Cancer Patients: A Retrospective Study

“…Hence, prior use of RABs did not result in increased mortality [ 2 ] and, conversely, likely improved survival in general intensive care unit (ICU) populations [ 3 , 4 ]. In ICU survivors who experienced acute kidney injury, RABs prescription after ICU discharge was associated with a decrease in one-year mortality [ 5 ], possibly linked to reduced incidence of major cardiac adverse events [ 6 ]. In a recent study by Angriman et al reporting the outcomes of 7174 sepsis survivors, a new treatment with RABs within 30 days of hospital discharge was associated with a reduction in major cardiovascular events (i.e., myocardial infarction, stroke) compared to new users of a calcium channel blocker or a thiazide diuretic [ 7 ].…”