The following is the summary of “Premorbid angiotensin converting enzyme inhibitors or angiotensin II receptor blockers in patients with sepsis” published in the December 2022 issue of Emergency medicine by Hasegawa, et al.

The purpose of this study was to systematically examine and meta-analyze the literature on the association between premorbid angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARB) use and short-term mortality in patients with sepsis. Studies meeting the following criteria were retrieved from the databases MEDLINE, COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS, and EMBASE. PROSPERO is aware of the protocol (CRD42022309129).

These are the requirements for participation: individuals with sepsis who were 16 or older and who either had premorbid ACEI/ARB or did not receive premorbid ACEI/ARB; or were enrolled in randomized controlled trials. Extracted data included patient and study characteristics and outcomes. Random-effects models were utilized for presentation of all analyses. About 30 day in-hospital or intensive care unit (ICU) mortality was the main endpoint. Acute renal damage was a secondary result. The number of eligible studies was 15, with a total of (N=96,159). 11 trials with a total of 40,360 participants provided unadjusted mortality rates in the short term. 

Short-term mortality was associated with premorbid ACEI/ARB use at a pooled odds ratio (OR) of Oral Relative Risk (OR)=0.86; 95% CI = 0.67-1.11; (P=0.24); I2 = 88%. There were 5 studies that presented adjusted odds ratios for short-term mortality associated with ACEI/ARB use prior to diagnosis. In this case, the odds ratio is 0.74 (95% CI: 0.59 to 0.93), the significance level is (P<0.01), and the inter-observer agreement is 93%. The pooled adjusted OR for acute kidney injury (AKI) when ACEI/ARBs were used beforehand was as follows, according to 7 studies: The odds ratio was 1.57 (95% CI, 1.26-1.96), (P<0.01), and the inter-observer variability was 69%. Despite the greatly increased risk of AKI, this meta-analysis found that premorbid ACEI/ARB use was linked with significantly decreased short-term mortality in patients with sepsis.