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Evaluating Risk Factors for Severe Renin-Angiotensin-Aldosterone System Inhibitor Induced Angioedema.

Govind Bindra1, Debendra Pattanaik2, Anthony Sheyn3,4,5

  • 1University of Tennessee Health Science Center, Memphis, Tennessee, USA.

The Laryngoscope
|December 8, 2025
PubMed
Summary

Identifying risk factors for renin-angiotensin-aldosterone system inhibitor (RAASi) induced angioedema is crucial for patient triage. Laryngeal swelling is a strong predictor of adverse outcomes in these patients.

Keywords:
angioedemaangiotensin II receptor blockerangiotensin‐converting enzyme inhibitorbradykininrisk factors

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Area of Science:

  • Emergency Medicine
  • Pharmacology
  • Critical Care Medicine

Background:

  • Renin-angiotensin-aldosterone system inhibitors (RAASi) can cause angioedema, a potentially life-threatening condition.
  • Effective triage of patients with RAASi-induced angioedema in the emergency department (ED) is essential for optimal patient outcomes.

Purpose of the Study:

  • To identify risk factors for hospital admission, intensive care unit (ICU) admission, and intubation in patients with RAASi-induced angioedema presenting to the ED.
  • To evaluate the predictive value of specific clinical findings, such as laryngeal and tongue swelling, for adverse outcomes.

Main Methods:

  • A retrospective cohort study of adult patients with RAASi-induced angioedema visiting the ED between 2006 and 2016.
  • Data collected included demographics, symptoms, comorbidities, medication history, intubation details, and adverse events.
  • Fiberoptic examination findings were analyzed for their association with clinical outcomes.

Main Results:

  • Laryngeal swelling (OR 133.79) and anterior tongue swelling (OR 4.15) were significant predictors of adverse outcomes, including intubation.
  • 33% of patients required ICU admission, and 16.2% needed intubation.
  • Models incorporating laryngeal swelling, anterior tongue swelling, and BMI demonstrated excellent predictive performance.

Conclusions:

  • Fiberoptic examination is a valuable tool for assessing the severity of RAASi-induced angioedema in the ED.
  • Key clinical factors, including laryngeal and tongue swelling, can effectively identify patients at high risk for severe complications, aiding in triage and management.