Korean J Crit Care Med.  2017 May;32(2):154-163. 10.4266/kjccm.2016.00976.

Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study

• Kim J
• Choi SM
• Lee J
• Park YS
• Lee CH
• Yim JJ
• Yoo CG
• Kim YW
• Han SK
• Lee SM

• KMID: 2384040
• DOI: http://doi.org/10.4266/kjccm.2016.00976

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.

Keyword

acute respiratory distress syndrome; angiotensin-converting enzyme inhibitors; angiotensin receptor antagonists; mortality; renin-angiotensin system

MeSH Terms

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
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Angiotensins

Figure

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  Figure 1. Enrollment and analysis of patients. ICU: intensive care unit; SNUH: Seoul National University Hospital; ARDS: acute respiratory distress syndrome.

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  Figure 2. Kaplan-Meier survival analysis. ACE: angiotensinconverting enzyme; ARB: angiotensin receptor blocker; ICU: intensive care unit.

Reference

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