scholarly journals Impact of ToxigenicClostridium difficileColonization on the Risk of SubsequentC. difficileInfection in Intensive Care Unit Patients

2015 ◽  
Vol 36 (11) ◽  
pp. 1324-1329 ◽  
Author(s):  
Sarah Tschudin-Sutter ◽  
Karen C. Carroll ◽  
Pranita D. Tamma ◽  
Madeleine L. Sudekum ◽  
Reno Frei ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Relative Risk ◽  
Independent Risk Factor ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Johns Hopkins Hospital ◽  
Increased Risk ◽  
Colonization Rates

BACKGROUNDClostridium difficileinfection (CDI) in hospitalized patients is generally attributed to the current stay, but recent studies reveal highC. difficilecolonization rates on admission.OBJECTIVETo determine the rate of colonization with toxigenicC. difficileamong intensive care unit patients upon admission as well as acquired during hospitalization, and the risk of subsequent CDI.METHODSProspective cohort study from April 15 through July 8, 2013. Adults admitted to an intensive care unit within 48 hours of admission to the Johns Hopkins Hospital, Baltimore, Maryland, were screened for colonization with toxigenicC. difficile. The primary outcome was risk of developing CDI.RESULTSAmong 542 patients, 17 (3.1%) were colonized with toxigenicC. difficileon admission and an additional 3 patients were found to be colonized during hospitalization. Both colonization with toxigenicC. difficileon admission and colonization during hospitalization were associated with an increased risk for development of CDI (relative risk, 10.29 [95% CI, 2.24–47.40],P=.003; and 15.66 [4.01–61.08],P<.001, respectively). Using multivariable analysis, colonization on admission and colonization during hospitalization were independent predictors of CDI (relative risk, 8.62 [95% CI, 1.48–50.25],P=.017; and 10.93 [1.49–80.20],P=.019, respectively), while adjusting for potential confounders.CONCLUSIONSIn intensive care unit patients, colonization with toxigenicC. difficileis an independent risk factor for development of subsequent CDI. Further studies are needed to identify populations with higher toxigenicC. difficilecolonization rates possibly benefiting from screening or avoidance of agents known to promote CDI.Infect. Control Hosp. Epidemiol.2015;36(11):1324–1329

scholarly journals Association between Malnutrition and Hospital Mortality and Duration of Intensive Care Unit Admission in the Critically Ill: A Prospective Cohort Study

2017 ◽  
Author(s):  
Charles Chin Han Lew ◽  
Gabriel Jun Yung Wong ◽  
Ka Po Cheung ◽  
Ai Ping Chua ◽  
Mary Foong Fong Chong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Prospective Cohort Study ◽  
Critically Ill Patients ◽  
Prospective Cohort ◽  
Unit Length ◽  
Increased Risk

There is limited evidence for the association between malnutrition and hospital mortality as well as Intensive Care Unit length-of-stay (ICU-LOS) in critically ill patients. We aimed to examine the aforementioned associations by conducting a prospective cohort study in an ICU of a Singapore tertiary hospital. Between August 2015 and October 2016, all adult patients with &ge;24 h of ICU-LOS were included. The 7-point Subjective Global Assessment (7-point SGA) was used to determine patients&rsquo; nutritional status within 48 hours of ICU admission. Multivariate analyses were conducted in two ways: 1) presence versus absence of malnutrition, and 2) dose-dependent association for each 1-point decrease in the 7-point SGA. There were 439 patients of which 28.0% were malnourished, and 29.6% died before hospital discharge. Malnutrition was associated with an increased risk of hospital mortality [adjusted-RR 1.39 (95%CI: 1.10&ndash;1.76)], and this risk increased with a greater degree of malnutrition [adjusted-RR 1.09 (95%CI: 1.01&ndash;1.18) for each 1-point decrease in the 7-point SGA]. No significant association was found between malnutrition and ICU-LOS. Conclusion: There was a clear association between malnutrition and higher hospital mortality in critically ill patients. The association between malnutrition and ICU-LOS could not be replicated and hence requires further evaluation.

scholarly journals Predictors of difficulty in bedside percutaneous dilatational tracheostomy: pilot study

2020 ◽  
Vol 47 ◽  
Author(s):  
LUCAS RIBEIRO TENÓRIO ◽  
MARIANNE YUMI NAKAI ◽  
JÚLIO PATROCÍNIO MORAES ◽  
MARCELO BENEDITO MENEZES ◽  
LETÍCIA DE MELO SILVA ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Pilot Study ◽  
Prospective Cohort ◽  
Percutaneous Dilatational Tracheostomy ◽  
Technical Difficulty ◽  
Single Center ◽  
Dilatational Tracheostomy ◽  
Increased Risk

ABSTRACT Introduction: percutaneous dilatational tracheostomy is currently one of the main procedures performed in an intensive care unit (ICU). However, there are no well-defined indicators of technical difficulty in performing the procedure. Objectives: to define predictors of difficulty in performing bedside percutaneous dilatational tracheostomy. Methodology: prospective cohort study encompassing 21 patients who underwent bedside percutaneous dilatational tracheostomy in the ICU at a single center. Results: Sternohyoid (SH) distance shorter than 7 cm is associated with a 50% increase in the risk of technical difficulty (OR 0.44 and p <0.03). Conclusion: the reduction in (SH) distance is related to an increased risk of difficulty in performing percutaneous dilatational tracheostomy in the ICU bed.

scholarly journals Adverse events during the intrahospital transfer of critically ill perioperative patients in a South African tertiary hospital

2020 ◽  
pp. 131-138
Author(s):  
LY Seilbea ◽  
K de Vasconcellos
Keyword(s):  
Intensive Care Unit ◽  
Adverse Event ◽  
Intensive Care ◽  
Adverse Events ◽  
South African ◽  
Critically Ill ◽  
Multivariable Analysis ◽  
Inotropic Support ◽  
Physiological Changes ◽  
Increased Risk

Background: Critically ill patients frequently require intrahospital transfer for diagnostic or therapeutic procedures, or transfer to the intensive care unit. Intrahospital transfer exposes patients to an increased risk of adverse events. The reported rate of adverse events ranges from 4.2% to 79% based on data from high income countries. There is limited data available on intrahospital transfers in the South African context. This study aimed to determine the incidence of adverse events during intrahospital transfer, the physiological effects of intrahospital transfer, identify potential risk factors for adverse events and determine if adverse events were associated with poor clinical outcomes. Methods: The study was a single-centre, prospective, observational study of adult patients undergoing transport between the operating theatre and the intensive care unit (or vice versa) of a tertiary academic hospital in South Africa. Demographic data, transfer data (including adverse events, and the physiological parameters of the patients before and after transfer), and intensive care unit outcome data was collected between September 2018 and May 2019. Results: Data on 94 transfers was collected. Adverse events occurred in 23.4% (95% CI 14.7–32.1%) of transfers. Clinical adverse events, namely hypotension requiring management, made up 55% of the adverse events, while the remaining were technical adverse events (32% monitor failure, 9% ventilator failure and 4% infusion pump failure). The median transfer time was 10 minutes. Patients who developed adverse events during transfer were significantly older (median age 48 years versus 37 years, p = 0.037) and were significantly more likely to be receiving inotropic support (81.8% versus 51.4%, OR 4.26; 95% CI 1.31–13.82, p = 0.011) than those who did not have adverse events. Only the association with inotropic support remained on multivariable analysis. Patients who suffered an adverse event during transfer had a significantly higher mortality than those who did not have an adverse event (63.6% versus 30.6%, OR 3.98; 95% CI 1.46–10.84, p = 0.005) on univariate analysis, however this association was no longer significant on multivariable analysis. Increasing age, inotropic support and transfer by a medical officer as opposed to a registrar remained significant predictors on multivariable analysis. Significant physiological changes were noted in 80.9% of patients, with 64.9% of patients showing deterioration in at least one physiological parameter. Conclusion: Adverse events are common during the transfer of critically ill patients between the operating theatre and the intensive care unit. Even in the absence of adverse events, physiological changes occur in the majority of patients undergoing transfer. Patients receiving inotropic support are at increased risk of adverse events during transfer and enhanced attention to pre-transfer preparation and intratransfer management is warranted in these patients. The potential associations between adverse events during transfer and transferring personnel and ICU mortality needs to be explored in further studies.

scholarly journals P401 Risk of severe COVID-19 outcomes associated with inflammatory bowel disease medications: Reassuring insights from the United Kingdom PREPARE-IBD multicentre cohort study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S409-S410
Author(s):  
C A Lamb ◽  
S Sebastian ◽  
A J Kent ◽  
J P Segal ◽  
H A Gonzalez ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Cohort Study ◽  
United Kingdom ◽  
Bowel Disease ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
British Society ◽  
The United Kingdom ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background During the early COVID-19 pandemic, the British Society of Gastroenterology (BSG) developed a risk stratification grid to inform the United Kingdom (UK) government regarding strict social isolation, termed “shielding”. This advised inflammatory bowel disease (IBD) patients thought to be most clinically vulnerable to SARS-CoV-2 infection or severe COVID-19 outcomes, to stay at home and minimize face to face contact, even with household members. Those considered at highest risk included recent commencement of combination biologic and immunomodulator therapy, prednisolone ≥20mg/day, presence of comorbidities, age ≥70 years or clinically active disease in those receiving immunosuppression. Mesalazine was not considered to increase risk. An acknowledged limitation was an absence of COVID-19 risk data. This study sought to identify patient or IBD medication-related factors associated with severe outcomes from COVID-19. Methods PREPARE-IBD was a multi-centre observational United Kingdom (UK) cohort study including adult IBD patients (≥18 years) diagnosed with COVID-19 by PCR between 1st March 2020 and 31st August 2020. The primary outcome was severe COVID-19 defined as requirement for intensive care admission, invasive ventilation or death. We tested associations of severe outcomes with medications and other covariates using multiple logistic regression. Results 211 patients were included from 60 UK centres. 56 of 211 patients (26.5%) met the primary outcome. Severe COVID-19 was more common in ulcerative colitis relative to Crohn’s disease patients (33.9% [37/109] vs. 18.6% [16/86], p=0.018). Shortness of breath, nausea and vomiting were more common with severe COVID-19 (p&lt;0.001 and p=0.023 respectively). Multivariable analysis identified co-morbidities and age as associated with severe COVID-19 outcomes; odds ratio (OR [95% CI]) 1.68 (1.23-2.35) for each co-morbidity, and an OR 1.03 (1.00-1.05) with each successive year of age. Neither clinically active IBD (OR 0.58 [0.26-1.26]), non-white ethnicity (OR 1.98 [0.92-4.28]), nor prednisolone use (OR 2.42 [0.47-11.26]) were associated with increased risk. On multivariable analysis, mesalazine was associated with severe COVID-19 outcomes (OR 2.03 [1.01-4.12]). Univariable analysis identified biologics and thiopurines as protective (OR 0.38 [0.15-0.87] and 0.32 [0.092-0.86] respectively). On multivariable analysis no association of severe COVID-19 outcomes with thiopurine or biologic exposure was seen. Conclusion Our data provide reassurance for the continued evidence-based use of corticosteroids, immunomodulators and biologic therapies in IBD during the ongoing COVID-19 pandemic, and is consistent with an as yet unexplained association between mesalazine use and severe COVID-19 outcomes.

scholarly journals RISK OF ADVERSE OUTCOMES IN HOSPITALIZED PATIENTS WITH AUTOIMMUNE DISEASE AND COVID-19: A MATCHED COHORT STUDY FROM NEW YORK CITY

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S44-S44
Author(s):  
Adam Faye ◽  
Kate Lee ◽  
Monika Laszkowska ◽  
Judith Kim ◽  
John Blackett ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Cohort Study ◽  
Intensive Care ◽  
Autoimmune Disease ◽  
Intensive Care Unit Admission ◽  
Hospitalized Patients ◽  
Secondary Outcome ◽  
Composite Outcome ◽  
Increased Risk

Abstract Objective To examine the impact of autoimmune disease on the composite outcome of intensive care unit admission, intubation, or death, from COVID-19 in hospitalized patients. Methods Retrospective cohort study of 186 patients hospitalized with COVID-19 between March 1st–April 15th, 2020 at New York-Presbyterian Hospital/Columbia University Irving Medical Center. The cohort included 62 patients with autoimmune disease and 124 age- and sex- matched controls. The primary outcome was a composite of intensive care unit admission, intubation, and death, with secondary outcome assessing time to in-hospital death. Baseline demographics, comorbidities, medications, vital signs, and laboratory values were collected. Conditional logistic regression and Cox proportional hazards regression were used to assess the association between autoimmune disease and clinical outcomes. Results Patients with autoimmune disease were more likely to have at least one comorbidity (25.8% vs. 12.9%, p=0.03), take chronic immunosuppressive medications (66.1% vs. 4.0%, p&lt;0.01), and have had a solid organ transplant (16.1% vs. 1.6%, p&lt;0.01). There were no significant differences in intensive care unit admission (14.2% vs. 19.4%, p=0.44), intubation (14.2% vs. 17.7%, p=0.62) or death (17.5% vs. 14.5%, p=0.77). On multivariable analysis, patients with autoimmune disease were not at an increased risk for a composite outcome of intensive care unit admission, intubation, or death (adjOR 0.79, 95%CI 0.37–1.67). On Cox regression, autoimmune disease was not associated with in-hospital mortality (adjHR 0.73, 95%CI 0.33–1.63). Conclusion Among patients hospitalized with COVID-19, individuals with autoimmune disease did not have an increased risk of a composite outcome of intensive care unit admission, intubation, or death. Kaplan-Meier curve examining death, stratified by the presence or absence of autoimmune disease in all 186 patients, with 16 patients censored as of 4/29/2020

scholarly journals Dexmedetomidine-Associated Hyperthermia: A Retrospective Cohort Study of Intensive Care Unit Admissions between 2009 and 2016

2017 ◽  
Vol 45 (6) ◽  
pp. 727-736 ◽  
Author(s):  
K. E. D. Grayson ◽  
A. E. Tobin ◽  
D. T. K. Lim ◽  
D. E. Reid ◽  
M. Ghani
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Increased Risk

Dexmedetomidine-associated hyperthermia has not been previously studied. Analysis is warranted to determine whether this potentially dangerous complication is more prevalent than previously realised. We aimed to examine the association between dexmedetomidine and temperature ≥39.5°C, including patient characteristics, temporality and potential risk factors. We conducted a retrospective cohort study of all intensive care unit (ICU) admissions between 1 July 2009 and 31 May 2016 in a tertiary ICU in Australia. Temperature data was available for 9,782 ICU admissions. Dexmedetomidine was given intravenously to 611 (6.3%) patients at a dose of 0 to 1.5 g/kg/hour. Temperatures ≥39.5°C were recorded in 341 (3.5%) patients. Overall hospital mortality was 10.8% for all admissions and 29.3% for patients with temperatures ≥39.5°C. Dexmedetomidine exposure was more frequent in patients with temperature recordings ≥39.5°C compared to those with temperatures <39.5°C, 11.94% versus 2.94% (odds ratio [OR] 4.49; 95% confidence intervals [CI] 3.37, 5.92; P <0.001). The association was stronger for patients post-open heart surgery (OHS) with temperatures ≥39.5°C (OR 12.9; 95% CI 5.01, 31.62; P <0.001). Multivariate analysis showed an independent association between dexmedetomidine and a temperature ≥39.5°C in two particular patient groups: OHS (OR 2.72; 95% CI 1.1, 6.9; P <0.001), and obesity (OR 3.44; 95% CI 1.5, 7.9; P <0.001). Dexmedetomidine exposure is associated with an increased risk of hyperthermia. Possible risk factors are open heart surgery and obesity.

scholarly journals The effects of in-hospital deprescribing on potential prescribing omission in hospitalized elderly patients with polypharmacy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Miho Kaminaga ◽  
Junpei Komagamine ◽  
Shinpei Tatsumi
Keyword(s):  
Elderly Patients ◽  
Independent Risk Factor ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Hospitalized Elderly ◽  
Start Criteria ◽  
Increased Risk ◽  
Prescribing Omissions ◽  
Hospitalized Elderly Patients ◽  
Potential Prescribing Omissions

AbstractNo studies to investigate the effect of a deprescribing intervention on the occurrence of potential prescribing omissions (PPOs) among elderly patients with polypharmacy have been conducted. Therefore, the effect of deprescribing on PPOs among elderly patients with polypharmacy was investigated. All 121 consecutive elderly patients who received in-hospital deprescribing interventions were evaluated. The primary outcome was any occurrence of PPOs based on the 2015 STOPP/START criteria. The proportion of patients who had any PPOs significantly increased after the deprescribing interventions (52.9% vs 77.7%, p < 0.001). In the multivariable analysis, older age was the only independent risk factor associated with an increased risk of any PPOs after the deprescribing interventions (OR 1.08, 95% CI 1.01 to 1.16). In-hospital deprescribing interventions for elderly patients with polypharmacy may increase the occurrence of PPOs. Further study is warranted to investigate the effects on clinical outcomes of the increased occurrence of PPOs due to the deprescribing intervention.

scholarly journals Thromboembolic Rates Are Similar Between Intensive Care Unit and Nonintensive Care Unit Hospitalized Patients With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Retrospective Cohort Study

2021 ◽  
Vol 27 ◽  
pp. 107602962110533
Author(s):  
Heidi Worth ◽  
Kasey Helmlinger ◽  
Renju Raj ◽  
Eric Heidel ◽  
Ronald Lands
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Thromboembolic Event ◽  
Hospitalized Patients ◽  
Thromboembolic Events ◽  
Icu Patients ◽  
Increased Risk

High rates of thromboembolic events have been described in intensive care unit (ICU) patients. Data regarding thromboembolic events in all hospitalized patients has been less frequently reported, raising concerns that thromboembolic events in non-ICU may be underrecognized. In addition, optimal anticoagulation type and dose is still unsettled at this time. This is a retrospective cohort study of 159 hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia during a 9-month period to determine an association between the frequency of thromboembolic rates and hospitalized patients with COVID-19. Secondary outcomes sought to investigate association of thromboembolic events with relation to place of admission, risk factors, anticoagulation, mortality, hospital length of stay, and discharge disposition. Among the cohort of 159 hospitalized patients who met criteria, 16 (10%) were diagnosed with a thromboembolic event. There were a total of 18 thromboembolic events with 12 venous and 6 arterial. Admission to the ICU was not associated with a higher frequency of thromboembolic events compared with non-ICU patients (37.5% vs 62.5%), p = .71. Patients with a thromboembolic event had a significantly higher mortality compared with those with no thromboembolic event (37.5% vs 13.3%), p = .012. Patients hospitalized with COVID-19 have increased rates of thromboembolic events, both venous and arterial, which contribute to a significant increase in mortality. However, the frequency of thromboembolism in patients admitted to the ICU was similar to events in non-ICU patients. We hope to increase awareness of the increased risk of hypercoagulability in all hospitalized patients with COVID-19 including non-ICU patients.

scholarly journals Perfusion Abnormalities Shown On Subtraction CT Angiography In Apparently Normal Lungs And Their Impact On Patient Outcome. A Prospective Cohort Study: What Could We Be Missing?

2021 ◽  
Author(s):  
Mario G. Santamarina ◽  
Felipe Martinez Lomakin ◽  
Ignacio Beddings ◽  
Dominique Boisier Riscal ◽  
Jose Chang Villacís ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Ct Angiography ◽  
Independent Risk Factor ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Increased Risk

Abstract Background: COVID-19 pneumonia seems to affect the regulation of pulmonary perfusion. In this study, through iodine distribution maps obtained with subtraction CT angiography, we quantified and analyzed perfusion abnormalities in patients with COVID-19 pneumonia and correlated them with clinical outcomes.Methods: 205 patients were included in this cohort, from two different tertiary-care hospitals in Chile. All patients had RT-PCR confirmed SARS-CoV-2 infection. CT scans were performed within 24 h of admission, in supine position. Airspace compromise was assessed with CT severity score, and the extension of hypoperfusion in apparently healthy lung parenchyma with perfusion score. CT severity and perfusion scores were then correlated with clinical outcomes. Multivariable analyses using Cox Proportional Hazards regression were used to control for clinical confounders.Results: Fourteen patients were excluded due to uninterpretable images. This left 191 patients, 112 males and 79 females. The mean age was 60.8±16.0 years. The median SOFA score on admission was 2 and average PaFi ratio was 250±118. Patients with severe perfusion abnormalities showed significantly higher SOFA scores and lower Pa/Fi ratios when compared to individuals with mild or moderate anomalies. Severe perfusion abnormalities were associated with an increased risk of intensive care unit (ICU) admission and the requirement of invasive mechanical ventilation (IMV).Conclusion: Patients with severe perfusion anomalies have a higher risk of admission to the ICU and IMV. Perfusion alterations could be considered as an independent risk factor in patients with COVID-19 pneumonia.Summary Statement: Lung perfusion abnormalities in patients with COVID-19 pneumonia were associated with admission to Intensive Care Unit and requirement of invasive mechanical ventilation. Perfusion abnormalities could be considered as an independent risk factor in patients with COVID-19 pneumonia.

scholarly journals Renin–Angiotensin System Blockers and Adverse Outcomes of Influenza and Pneumonia: A Danish Cohort Study

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Christian Fynbo Christiansen ◽  
Uffe Heide‐Jørgensen ◽  
Thomas Bøjer Rasmussen ◽  
Jacob Bodilsen ◽  
Ole Schmeltz Søgaard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Propensity Score ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Angiotensin Receptor Blockers ◽  
Channel Blockers ◽  
Increased Risk ◽  
The Impact

Background Angiotensin‐converting enzyme inhibitors (ACE‐Is) and angiotensin receptor blockers (ARBs) may worsen the prognosis of coronavirus disease 2019, but any association could be confounded by the cardiometabolic conditions indicating ACE‐I/ARB use. We therefore examined the impact of ACE‐Is/ARBs on respiratory tract infection outcomes. Methods and Results This cohort study included all adult patients hospitalized with influenza or pneumonia from 2005 to 2018 in Denmark using population‐based medical databases. Thirty‐day mortality and risk of admission to the intensive care unit in ACE‐Is/ARBs users was compared with nonusers and with users of calcium channel blockers. We used propensity scores to handle confounding and computed propensity score‐weighted risks, risk differences (RDs), and risk ratios (RRs). Of 568 019 patients hospitalized with influenza or pneumonia, 100 278 were ACE‐I/ARB users and 37 961 were users of calcium channel blockers. In propensity score‐weighted analyses, ACE‐I/ARB users had marginally lower 30‐day mortality than users of calcium channel blockers (13.9% versus 14.5%; RD, −0.6%; 95% CI, −1.0 to −0.1; RR, 0.96; 95% CI, 0.93–0.99), and a lower risk of admission to the intensive care unit (8.0% versus 9.6%; RD, −1.6%; 95% CI, −2.0 to −1.2; RR, 0.83; 95% CI, 0.80–0.87). Compared with nonusers, current ACE‐I/ARB users had lower mortality (RD, −2.4%; 95% CI, −2.8 to −2.0; RR, 0.85; 95% CI, 0.83–0.87), but similar risk of admission to the intensive care unit (RD, 0.4%; 95% CI, 0.0–0.7; RR, 1.04; 95% CI, 1.00–1.09). Conclusions Among patients with influenza or pneumonia, ACE‐I/ARB users had no increased risk of admission to the intensive care unit and slightly reduced mortality after controlling for confounding.

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