Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study
- Author:
Joohae KIM
1
;
Sun Mi CHOI
;
Jinwoo LEE
;
Young Sik PARK
;
Chang Hoon LEE
;
Jae Joon YIM
;
Chul Gyu YOO
;
Young Whan KIM
;
Sung Koo HAN
;
Sang Min LEE
Author Information
- Publication Type:Original Article
- Keywords: acute respiratory distress syndrome; angiotensin-converting enzyme inhibitors; angiotensin receptor antagonists; mortality; renin-angiotensin system
- MeSH: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Angiotensins; Berlin; Case-Control Studies; Fibrosis; Humans; Inflammation; Intensive Care Units; Lung; Medical Records; Mortality; Prognosis; Propensity Score; Renin-Angiotensin System; Respiration, Artificial; Respiratory Distress Syndrome, Adult; Retrospective Studies; Survival Rate; Tertiary Healthcare
- From:The Korean Journal of Critical Care Medicine 2017;32(2):154-163
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Acute respiratory distress syndrome (ARDS) remains a life-threatening disease. Many patients with ARDS do not recover fully, and progress to terminal lung fibrosis. Angiotensin-converting enzyme (ACE) inhibitor is known to modulate the neurohormonal system to reduce inflammation and to prevent tissue fibrosis. However, the role of ACE inhibitor in the lungs is not well understood. We therefore conducted this study to elucidate the effect of renin-angiotensin system (RAS) blockage on the prognosis of patients with ARDS. METHODS: We analyzed medical records of patients who were admitted to the medical intensive care unit (ICU) at a tertiary care hospital from January 2005 to December 2010. ARDS was determined using the Berlin definition. The primary outcome was the mortality rate of ICU. Survival analysis was performed after adjustment using propensity score matching. RESULTS: A total of 182 patients were included in the study. Thirty-seven patients (20.3%) took ACE inhibitor or angiotensin receptor blocker (ARB) during ICU admission, and 145 (79.7%) did not; both groups showed similar severity scores. In the ICU, mortality was 45.9% in the RAS inhibitor group and 58.6% in the non-RAS inhibitor group (P = 0.166). The RAS inhibitor group required a longer duration of mechanical ventilation (29.5 vs. 19.5, P = 0.013) and longer ICU stay (32.1 vs. 20.2 days, P < 0.001). In survival analysis, the RAS inhibitor group showed better survival rates than the non-RAS group (P < 0.001). CONCLUSIONS: ACE inhibitor or ARB may have beneficial effect on ARDS patients.
