The Association of Renin-Angiotensin System Blockades and Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure: A Retrospective Cohort Study

Overview

Journal Int J Chron Obstruct Pulmon Dis

Publisher Dove Medical Press

Specialty Pulmonary Medicine

Date 2022 Sep 8

PMID 36072611

Authors

Zhishen Ruan

Dan Li

Yuanlong Hu

Zhanjun Qiu

Xianhai Chen

Affiliations

Soon will be listed here.

Abstract

Background: Acute respiratory failure (ARF) is a common cause of admission to the intensive care unit (ICU) for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). There is still a lack of effective interventions and treatments. ACE inhibitors (ACEI)/ angiotensin II receptor blockers (ARB) were effective in COPD patients. We aimed to study the effect of ACEI/ARB use on AECOPD combined with ARF and evaluate the effect of in-hospital continuation of medication.

Methods: We included patients with AECOPD and ARF from the Medical Information Bank for Intensive Care (MIMIC-III) database. MIMIC III is a large cohort database from Boston, USA. Patients were divided into two groups according to the use of ACEI/ARB before admission. Propensity score matching (PSM) was used to reduce potential bias between the two groups. Cox regression and Kaplan-Meier curves compared 30-day mortality in ACEI/ARB users and non-users. We also defined and analyzed the use of in-hospital ACEI/ARB. Multiple models were used to ensure the robustness of the findings. Subgroup analysis was used to analyze the variability between groups.

Results: A total of 544 patients were included in the original study. After PSM, 256 patients were included in the matched cohort. Multivariate Cox regression showed 30-day mortality was significantly lower in ACEI/ARB users compared with controls (HR = 0.50, 95% CI: 0.29-0.86, = 0.013). In PSM and inverse probability-weighted models, the results are stable Continued in-hospital use of ACEI/ARB remains effective (HR 0.40, 95% CI 0.22-0.74, = 0.003). Kaplan-Meier showed a significant difference in survival between the two groups.

Conclusion: This study found that pre-hospital ACEI/ARB use was associated with reduced mortality in patients with AECOPD and ARF.

Citing Articles

A 7-point evidence-based care discharge protocol for patients hospitalized for exacerbation of COPD: consensus strategy and expert recommendation.

Salvi S, Ghorpade D, Nair S, Pinto L, Singh A, Venugopal K NPJ Prim Care Respir Med. 2024; 34(1):44.

PMID: 39706845 PMC: 11662074. DOI: 10.1038/s41533-024-00378-7.

Cardiovascular diseases or type 2 diabetes mellitus and chronic airway diseases: mutual pharmacological interferences.

Cazzola M, Rogliani P, Ora J, Calzetta L, Matera M Ther Adv Chronic Dis. 2023; 14:20406223231171556.

PMID: 37284143 PMC: 10240559. DOI: 10.1177/20406223231171556.

Could patients with chronic obstructive pulmonary disease benefit from renin angiotensin system inhibitors? A meta-analysis.

Lv H, Huang J, Miao M, Huang C, Hang W, Xu Y BMJ Open Respir Res. 2023; 10(1).

PMID: 36828646 PMC: 9972452. DOI: 10.1136/bmjresp-2022-001569.

References

Tejwani V, Fawzy A, Putcha N, Castaldi P, Cho M, Pratte K . Emphysema Progression and Lung Function Decline Among Angiotensin Converting Enzyme Inhibitors and Angiotensin-Receptor Blockade Users in the COPDGene Cohort. Chest. 2021; 160(4):1245-1254. PMC: 8546238. DOI: 10.1016/j.chest.2021.05.007. View

Bidulka P, Fu E, Leyrat C, Kalogirou F, McAllister K, Kingdon E . Stopping renin-angiotensin system blockers after acute kidney injury and risk of adverse outcomes: parallel population-based cohort studies in English and Swedish routine care. BMC Med. 2020; 18(1):195. PMC: 7389346. DOI: 10.1186/s12916-020-01659-x. View

Elze M, Gregson J, Baber U, Williamson E, Sartori S, Mehran R . Comparison of Propensity Score Methods and Covariate Adjustment: Evaluation in 4 Cardiovascular Studies. J Am Coll Cardiol. 2017; 69(3):345-357. DOI: 10.1016/j.jacc.2016.10.060. View

Vandenbroucke J, von Elm E, Altman D, Gotzsche P, Mulrow C, Pocock S . Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007; 18(6):805-35. DOI: 10.1097/EDE.0b013e3181577511. View

Benigni A, Cassis P, Remuzzi G . Angiotensin II revisited: new roles in inflammation, immunology and aging. EMBO Mol Med. 2010; 2(7):247-57. PMC: 3377325. DOI: 10.1002/emmm.201000080. View

Hanif K, Bid H, Konwar R . Reinventing the ACE inhibitors: some old and new implications of ACE inhibition. Hypertens Res. 2009; 33(1):11-21. DOI: 10.1038/hr.2009.184. View

Curtis K, Meyrick V, Mehta B, Haji G, Li K, Montgomery H . Angiotensin-Converting Enzyme Inhibition as an Adjunct to Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2016; 194(11):1349-1357. PMC: 5148142. DOI: 10.1164/rccm.201601-0094OC. View

Jeffery M, Cummins N, Dempsey T, Limper A, Shah N, Bellolio F . Association of outpatient ACE inhibitors and angiotensin receptor blockers and outcomes of acute respiratory illness: a retrospective cohort study. BMJ Open. 2021; 11(3):e044010. PMC: 7978099. DOI: 10.1136/bmjopen-2020-044010. View

He X, Han B, Mura M, Xia S, Wang S, Ma T . Angiotensin-converting enzyme inhibitor captopril prevents oleic acid-induced severe acute lung injury in rats. Shock. 2007; 28(1):106-11. DOI: 10.1097/SHK.0b013e3180310f3a. View

10.

Chao J, Donham P, van Rooijen N, Wood J, Gonzalez N . Monocyte chemoattractant protein-1 released from alveolar macrophages mediates the systemic inflammation of acute alveolar hypoxia. Am J Respir Cell Mol Biol. 2010; 45(1):53-61. PMC: 3145071. DOI: 10.1165/rcmb.2010-0264OC. View

11.

Lai C, Wang Y, Wang C, Wang H, Yu C, Chen L . Comparative effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on the risk of pneumonia and severe exacerbations in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2018; 13:867-874. PMC: 5846309. DOI: 10.2147/COPD.S158634. View

12.

Tan W, Liao W, Zhou S, Mei D, Wong W . Targeting the renin-angiotensin system as novel therapeutic strategy for pulmonary diseases. Curr Opin Pharmacol. 2017; 40:9-17. DOI: 10.1016/j.coph.2017.12.002. View

13.

Zhang W, Wang Y, Wang J, Wang S . Association between red blood cell distribution width and long-term mortality in acute respiratory failure patients. Sci Rep. 2020; 10(1):21185. PMC: 7713121. DOI: 10.1038/s41598-020-78321-2. View

14.

Lin C, Tsai C, Sun Y, Hsieh W, Lin Y, Chen C . Instillation of particulate matter 2.5 induced acute lung injury and attenuated the injury recovery in ACE2 knockout mice. Int J Biol Sci. 2018; 14(3):253-265. PMC: 5859472. DOI: 10.7150/ijbs.23489. View

15.

Fortis S, Gao Y, OShea A, Beck B, Kaboli P, Vaughan Sarrazin M . Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation. Int J Chron Obstruct Pulmon Dis. 2021; 16:3157-3166. PMC: 8609200. DOI: 10.2147/COPD.S321053. View

16.

Raiden S, Nahmod K, Nahmod V, Semeniuk G, Pereira Y, Alvarez C . Nonpeptide antagonists of AT1 receptor for angiotensin II delay the onset of acute respiratory distress syndrome. J Pharmacol Exp Ther. 2002; 303(1):45-51. DOI: 10.1124/jpet.102.037382. View

17.

Kaparianos A, Argyropoulou E . Local renin-angiotensin II systems, angiotensin-converting enzyme and its homologue ACE2: their potential role in the pathogenesis of chronic obstructive pulmonary diseases, pulmonary hypertension and acute respiratory distress syndrome. Curr Med Chem. 2011; 18(23):3506-15. DOI: 10.2174/092986711796642562. View

18.

Yang Q, Zheng J, Wen D, Chen X, Chen W, Chen W . Association between metformin use on admission and outcomes in intensive care unit patients with acute kidney injury and type 2 diabetes: A retrospective cohort study. J Crit Care. 2021; 62:206-211. DOI: 10.1016/j.jcrc.2020.12.007. View

19.

Khan A, Benthin C, Zeno B, Albertson T, Boyd J, Christie J . A pilot clinical trial of recombinant human angiotensin-converting enzyme 2 in acute respiratory distress syndrome. Crit Care. 2017; 21(1):234. PMC: 5588692. DOI: 10.1186/s13054-017-1823-x. View

20.

Mancini G, Etminan M, Zhang B, Levesque L, FitzGerald J, Brophy J . Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease. J Am Coll Cardiol. 2006; 47(12):2554-60. DOI: 10.1016/j.jacc.2006.04.039. View