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

Identifying risk factors for hospital admission, intensive care unit (ICU) admission, and intubation in patients presenting to the emergency department (ED) with renin-angiotensin-aldosterone system inhibitor (RAASi) induced angioedema.

This single hospital-based retrospective cohort study examined ED visits of adult RAASi angioedema patients between January 1, 2006, and August 31, 2016. Clinical events were recorded over the ED visit and the next 2 months. Data extracted included demographics (age, sex, race), symptoms, exam findings, comorbidities, and medication history, intubation details (including difficulty, methods used), and adverse events (hypoxia, cardiac arrest, death). Patient courses, ICU care need, clinical deterioration, therapies, and length of stay were also documented.

Of the 755 patients meeting inclusion criteria from our cohort of 1299 patients, 16.2% required intubation during their admission, with 33% admitted to the ICU and 57% to regular hospital floors. Laryngeal swelling was the strongest predictor of adverse outcomes (OR 133.79, p < 0.001), followed by anterior tongue swelling (OR 4.15, p < 0.001), supporting fiberoptic exam as a valuable step in evaluating RAASi angioedema patients. Lip swelling was associated with a decreased likelihood of adverse outcomes such as intubation (OR 0.55, p = 0.049). Shortness of breath did not reliably predict advanced airway outcomes (p = 0.278). Efficiency models incorporating laryngeal swelling, anterior tongue swelling, and body mass index (BMI) achieved excellent predictive performance (AIC 364.43).

In the largest study of single-site RAASi angioedema patients who underwent fiberoptic laryngoscopy at admission, we identified key clinical factors for more effectively triaging patients at risk for significant angioedema complications.