Impact of Prior Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use on Delirium Incidence...

This investigation aimed at exploring the impact that the pre-existing use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) has on the incidence of delirium in patients within the intensive care unit (ICU).

A retrospective investigation was conducted by utilizing the Medical Information Mart for Intensive Care dataset spanning from 2008 to 2022 (version 3.0). The primary endpoint of the study was the onset of delirium during the patients' 30-day stay in the ICU. Secondary endpoints incorporated the duration of ICU stay, the period of vasoactive drug administration, the incidence rate of acute kidney injury (AKI), and the necessity for continuous renal replacement therapy (CRRT).

A total of 15,666 patients were included in the analysis. Among them, 6,942 patients had no prior use of ACEIs or ARBs, 6,643 patients used ACEIs, and 2,081 patients used ARBs. The mean age of the patients was 66.2 ± 15.5 years, 56.4% were male, and 62% experienced delirium. Multivariable Cox regression models revealed significant hazard ratios (HRs) for patients who received ACEIs and ARBs. After adjusting for all confounding variables, both ACEIs and ARBs were significantly associated with a reduced risk of delirium (HR: 0.13, 95% CI: 0.13-0.15 for ACEIs; HR: 0.13, 95% CI: 0.12-0.14 for ARBs). The use of ACEIs was significantly associated with a lower risk of AKI (HR: 0.9, 95% CI: 0.82-0.98). Additionally, both ACEIs and ARBs were significantly associated with a decreased need for CRRT.

Despite the significant association between the utilization of ACEIs or ARBs and a reduced incidence of delirium in critically ill patients, additional research is necessary to validate these results.