在患有败血症的重症老年患者中,先前使用宁- 血管素系统抑制剂和脏替代疗法的风险:基于人口的队列研究
Victoria Otero Castro1,2, Damon C Scales3,4,5,6, Federico Angriman3,4,5,6
1Critical Care Department, Sanatorio de los Arcos, Buenos Aires, Argentina.
Critical care explorations
|August 26, 2025
概括
慢性使用氨酸- 血管激素系统抑制剂在危急性败血症患者中增加了急性损伤的风险,需要替代疗法和败血症休克.
科学领域:
- 肝脏病学
- 危急护理医学
- 药理学
背景情况:
- 败血症是重症患者急性损伤的主要原因.
- 列宁- 血管系统抑制剂 (RASi) 常用于心血管疾病.
- 慢性RASi使用对败血症结局的影响,特别是需要置换疗法 (RRT) 的AKI,尚未得到充分证实.
研究的目的:
- 估计慢性使用氨酸血管系统抑制剂 (RASi) 与急性损伤需要置换疗法 (AKI- RRT) 之间的关联.
- 调查RASi使用与包括败血症和30天全因死亡率在内的二次结果之间的关联.
主要方法:
- 在加拿大安大略省进行基于人口的队列研究 (2008年4月至2019年3月).
- 包括患有败血症入院的老年患者;不包括已确定的RASi指示患者.
- 以往使用RASi (ACE抑制剂或ARB) 与以往使用通道阻断剂 (CCB) 作为活性比较剂的比较.
主要成果:
- 包括8621名患者;81%接受RASi;平均年龄为78岁.
- 与CCB相比,先前使用RASi与AKI- RRT风险增加了57% (RR,1.57;95%CI,1. 10-2. 24).
- 使用RASi也与感染性休克的风险增加有关 (RR,1. 18;95% CI,1. 04-1.33) 但与30天死亡率无关 (RR,0. 93;95% CI,0. 88-1. 01).
结论:
- 慢性使用素- 血管素系统抑制剂与急性损伤的风险增加有关,需要症患者进行替代治疗.
- 这些发现表明,在败血症期间,慢性RASi治疗的患者中,败血症的风险可能会增加.
- 在所有敏感性分析中,结果保持稳定,支持观察到的关联.
相关概念视频
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
505
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
505
Antihypertensive Drugs: Direct Renin Inhibitors
819
The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
819
Acute Kidney Injury IV: Diagnostic Studies and Prevention
57
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
57
Acute Kidney Injury I: Introduction
72
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
72
Renal Failure: Dose Adjustments
153
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
153
Acute Kidney Injury V: Interprofessional Care
44
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
44


