Renin-Angiotensin-Aldosterone Medication Use and Outcomes in Injured Patients Receiving Blood

Area of Science:

• Trauma resuscitation
• Pharmacology
• Critical care medicine

Background:

• Renin-angiotensin-aldosterone system (RAAS) modulators like ACE-Is and ARBs improve sepsis survival.
• Early blood transfusions enhance outcomes in trauma patients.
• The combined effect of preinjury ACE-I/ARB use and blood transfusion in trauma is not well understood.

Purpose of the Study:

• To investigate the association between preinjury ACE-I/ARB use and outcomes in trauma patients who received blood transfusions.
• To identify predictors of mortality in this patient population.

Main Methods:

• Retrospective analysis of trauma patients who received blood transfusions.
• Comparison of outcomes between patients with and without preinjury ACE-I/ARB exposure.
• Evaluation of demographics, complications, transfusion volumes, and mortality.
• Univariate and multivariable logistic regression analyses were performed.

Main Results:

• Of 1013 transfused patients, 220 (21.7%) had preinjury ACE-I/ARB use.
• Preinjury ACE-I/ARB use was linked to lower 24-hour mortality (10% vs. 17.9%, P=0.01).
• ACE-I/ARB use remained an independent predictor of reduced early mortality after adjusting for confounders.
• Preinjury ACE-I/ARB use was associated with a higher risk of acute kidney injury (OR: 2.57).

Conclusions:

• Preinjury use of RAAS-modulating medications (ACE-Is/ARBs) is associated with improved short-term outcomes in trauma patients receiving blood resuscitation.
• While beneficial for early survival, preinjury ACE-I/ARB use may increase the risk of acute kidney injury in this cohort.