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ACEI/ARB Medication During ICU Stay Decrease All-Cause In-hospital Mortality in Critically Ill Patients With
Boshen Yang1, Sixuan Xu2, Di Wang1
1Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Frontiers in Cardiovascular Medicine
|January 31, 2022
Summary
Angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) use in critically ill hypertensive patients was associated with significantly lower in-hospital mortality. This finding highlights the potential survival benefit of ACEI/ARB medications in this vulnerable patient population.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Cardiovascular Disease
Background:
- Hypertension is a frequent comorbidity in critically ill patients.
- Critically ill patients with hypertension may experience higher hospital mortality.
- High blood pressure is defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg.
Purpose of the Study:
- To investigate the association between the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) during intensive care unit (ICU) stay and all-cause in-hospital mortality.
- To explore the impact of ACEI/ARB medication on survival rates in critically ill patients with hypertension.
Main Methods:
- Retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (2008-2019).
- Inclusion criteria: adults with hypertension on admission or high blood pressure during ICU stay.
- Propensity score matching (PSM) and machine learning models (LightGBM) were employed to analyze associations and predict mortality, with SHAP values for feature importance.
Main Results:
- A total of 15,352 patients were analyzed, with 33.8% receiving ACEI/ARB.
- ACEI/ARB treatment was associated with significantly lower all-cause in-hospital mortality (3.9% vs. 12.7%) and 28-day mortality (3.6% vs. 12.2%).
- The LightGBM model demonstrated high predictive performance (AUC = 0.9935), with ACEI/ARB use identified as a key factor associated with reduced mortality.
Conclusions:
- ACEI/ARB use in critically ill hypertensive patients during ICU stay is linked to reduced all-cause in-hospital mortality.
- ACEI/ARB medication demonstrated an independent association with increased survival in a diverse group of critically ill hypertensive patients.
- These findings suggest a potential benefit of continuing or initiating ACEI/ARB therapy in managing hypertensive patients within the ICU setting.
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