Regional distribution of high-attenuation areas on chest computed tomography in the Multi-Ethnic Study of Atherosclerosis

High-attenuation areas (HAA) are a computed tomography-based quantitative measure of subclinical interstitial lung disease (ILD). We aimed to validate HAA in lung regions that are less subject to artefacts, such as extravascular lung water or dependent atelectasis. We examined the associations of HAA within six lung regions (basilar, non-basilar, peel, core, basilar peel, basilar core) with serum biomarkers of lung remodelling, forced vital capacity (FVC), visually-assessed interstitial lung abnormalities (ILA), and all-cause and ILD-specific mortality.We performed cross-sectional and longitudinal analyses of participants in the Multi-Ethnic Study of Atherosclerosis, a prospective cohort of 6814 adults aged 45–84 years without known cardiovascular disease who underwent cardiac computed tomography.Median regional HAA ranged from 3.8% in the peel to 4.8% in the basilar core. Doubling of regional HAA was associated with greater serum matrix metalloproteinase-7 (range 3.8% to 10.3%; p≤0.01), higher odds of ILA (OR 1.42 to 2.20; p≤0.03), and a higher risk of all-cause mortality (hazard ratio 1.20 to 1.47; p≤0.001). Doubling of regional HAA was associated with greater serum interleukin-6 (4.9% to 10.3%; p≤0.005) and higher risk of ILD-specific mortality (hazard ratio 3.30 to 3.98; p<0.001), except in the basilar core. Doubling of regional HAA was associated with lower FVC in the non-basilar, core and basilar core (113 mL to 186 mL; p<0.001).Associations of HAA with lung remodelling biomarkers, ILA risk and all-cause mortality were consistent across all regions of the lung, including dependent areas where atelectasis may be present. These findings support the validity of HAA as a measure of pathologic subclinical ILD.

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Duration and Life-Stage of Antibiotic Use and Risks of All-Cause and Cause-Specific Mortality

Circulation Research ◽

10.1161/circresaha.119.315279 ◽

2020 ◽

Vol 126 (3) ◽

pp. 364-373 ◽

Cited By ~ 3

Author(s):

Yoriko Heianza ◽

Wenjie Ma ◽

Xiang Li ◽

Yin Cao ◽

Andrew T. Chan ◽

...

Keyword(s):

Cardiovascular Disease ◽

Life Stage ◽

Antibiotic Use ◽

Hazard Ratio ◽

Antibiotic Exposure ◽

Late Adulthood ◽

Mortality Hazard ◽

All Cause Mortality ◽

Specific Mortality ◽

Mortality Hazard Ratio

Rationale: The overuse of antibiotics has been an important clinical issue, and antibiotic exposure is linked to alterations in gut microbiota, which has been related to risks of various chronic diseases such as cardiovascular disease and cancer. Also, duration of antibiotic exposure may be a risk factor of premature death. Objective: We investigated associations of life-stage and duration of antibiotic use during adulthood with risks of all-cause and cause-specific mortality. Methods and Results: This prospective cohort study included 37 516 women aged ≥60 years who were free of cardiovascular disease or cancer from the Nurses’ Health Study. Participants reported a total amount of time they used antibiotics (none, <15 days, 15 days to <2 months, or ≥2 months) in the middle- (age, 40–59) and late adulthood (age, 60 or older). We estimated hazard ratios for all-cause mortality and deaths from cardiovascular disease or cancer over 10 years according to duration of antibiotic use. During 355 918 person-years of follow-up, we documented 4536 deaths from any cause (including 728 cardiovascular deaths and 1206 cancer deaths). As compared with women who did not use antibiotics, those who used them for ≥2 months in late adulthood had increased risks of all-cause mortality (hazard ratio, 1.16 [95% CI, 1.01–1.33]) and cardiovascular mortality (hazard ratio, 1.49 [95% CI, 1.04–2.13]), but not cancer mortality (hazard ratio, 0.85 [95% CI, 0.65–1.12]) after adjustment for chronic metabolic diseases, antibiotic use during middle adulthood, indication for use, demographic factors, and lifestyle/dietary factors. The association was more evident among women who also used antibiotics in middle-adulthood than among those who did not use during this life-stage. Conclusions: Long-term use of antibiotics in late adulthood may be a risk factor for all-cause and cardiovascular mortality. The unfavorable effect of antibiotic exposure for subsequent risks of deaths due to chronic diseases needs to be considered.

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Abstract 4531: Statin Use Is Associated with Decreased Mortality in Persons with Peripheral Arterial Disease

Circulation ◽

10.1161/circ.118.suppl_18.s_905-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Himabindu Vidula ◽

Lu Tian ◽

Kiang Liu ◽

Mary M McDermott

Keyword(s):

Arterial Disease ◽

Hazard Ratio ◽

Mortality Hazard ◽

All Cause Mortality ◽

Interaction Term ◽

Peripheral Arterial ◽

Mortality Hazard Ratio ◽

Statin Use ◽

Cvd Mortality

We determined whether statin use was associated with lower all-cause and cardiovascular disease (CVD) mortality in persons with lower extremity peripheral arterial disease (PAD). We also determined whether favorable associations of statin use with mortality were stronger in persons with higher C-reactive protein (CRP) compared to those with lower CRP levels. Participants were 681 men and women with PAD from the Walking and Leg Circulation Study (WALCS) and WALCS II prospective cohort studies. Participants were identified from non-invasive vascular laboratories in Chicago. Participants attended a baseline visit and annual visits for a mean follow-up of 3.7 years. Statin use was determined at baseline and each annual visit. Outcome measures were all-cause and CVD mortality. Time dependent Cox regression analyses were used to evaluate associations of statin use and mortality. Analyses were also repeated separately in participants with baseline CRP values above vs. below the median for the cohort. Analyses were adjusted for age, sex, race, comorbid conditions, ankle brachial index, total cholesterol, high density lipoprotein cholesterol, and other confounders. One hundred fifty five (23%) persons died during follow-up. Two hundred ninety (43%) persons were on a statin at baseline. At baseline, median CRP level was 2.6 mg/L. Statin use was associated with significantly lower all-cause mortality (hazard ratio, 0.52 [95% CI, 0.31 to 0.88], P = 0.014) and CVD mortality (hazard ratio, 0.41 [95% CI, 0.17 to 0.99], P = 0.048) as compared to statin non-use. In persons with CRP >2.6 mg/L, statin use was associated with a significantly lower risk of all-cause mortality (hazard ratio, 0.44 [95% CI, 0.23 to 0.88], P = 0.019, interaction term P = 0.67) and CVD mortality (hazard ratio, 0.20 [95% CI, 0.06 to 0.65], P = 0.0075, interaction term P = 0.39). However, in persons with CRP < 2.6 mg/L, statin use was not associated with lower mortality. Among persons with PAD, statin use is associated with significantly lower all-cause and CVD mortality at mean follow-up of 3.7 years. This finding is largely attributable to favorable associations of statin use with lower mortality among PAD patients with elevated baseline CRP levels.

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Impact of cardiorespiratory fitness on survival in men with low socioeconomic status

European Journal of Preventive Cardiology ◽

10.1177/2047487319901057 ◽

2020 ◽

pp. 204748731990105

Author(s):

Sae Young Jae ◽

Sudhir Kurl ◽

Kanokwan Bunsawat ◽

Barry A Franklin ◽

Jina Choo ◽

...

Keyword(s):

Cardiovascular Disease ◽

Low Socioeconomic Status ◽

Hazard Ratio ◽

Low Ses ◽

Low Socioeconomic ◽

Cardiovascular Disease Mortality ◽

Mortality Hazard ◽

Disease Mortality ◽

All Cause Mortality ◽

Mortality Hazard Ratio

Aims Although both low socioeconomic status (SES) and poor cardiorespiratory fitness (CRF) are associated with increased chronic disease and heightened mortality, it remains unclear whether moderate-to-high levels of CRF are associated with survival benefits in low SES populations. This study evaluated the hypothesis that SES and CRF predict all-cause mortality and cardiovascular disease mortality and that moderate-to-high levels of CRF may attenuate the association between low SES and increased mortality. Methods This study included 2368 men, who were followed in the Kuopio Ischaemic Heart Disease Study cohort. CRF was directly measured by peak oxygen uptake during progressive exercise testing. SES was characterized using self-reported questionnaires. Results During a 25-year median follow-up, 1116 all-cause mortality and 512 cardiovascular disease mortality events occurred. After adjusting for potential confounders, men with low SES were at increased risks for all-cause mortality (hazard ratio 1.49, 95% confidence interval: 1.30–1.71) and cardiovascular disease mortality (hazard ratio1.38, 1.13–1.69). Higher levels of CRF were associated with lower risks of all-cause mortality (hazard ratio 0.54, 0.45–0.64) and cardiovascular disease mortality (hazard ratio 0.53, 0.40–0.69). In joint associations of SES and CRF with mortality, low SES-unfit had significantly higher risks of all-cause mortality (hazard ratio 2.15, 1.78–2.59) and cardiovascular disease mortality (hazard ratio 1.95, 1.48-2.57), but low SES-fit was not associated with a heightened risk of cardiovascular disease mortality (hazard ratio 1.09, 0.80-1.48) as compared with their high SES-fit counterparts. Conclusion Both SES and CRF were independently associated with subsequent mortality; however, moderate-to-high levels of CRF were not associated with an excess risk of cardiovascular disease mortality in men with low SES.

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Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796015001171 ◽

2016 ◽

Vol 26 (2) ◽

pp. 189-198 ◽

Cited By ~ 6

Author(s):

J. Damián ◽

R. Pastor-Barriuso ◽

E. Valderrama-Gama ◽

J. de Pedro-Cuesta

Keyword(s):

Depressive Symptoms ◽

Nursing Homes ◽

Life Expectancy ◽

Hazard Ratio ◽

Mortality Hazard ◽

All Cause Mortality ◽

Mortality Hazard Ratio ◽

Long Term Mortality

Background.Studies on depression and mortality in nursing homes have shown inconclusive findings, and none has studied the role of detection. We sought to measure the association of depression with long-term all-cause mortality in institutionalised older people and evaluate a potential modification in the association by its detection status.Methods.We selected a stratified cluster sample of 591 residents aged 75 years or older (mean age 84.5 years) living in residential and nursing homes of Madrid, Spain, who were free of severe cognitive impairment at the 1998–1999 baseline interview. Mortality was ascertained until age 105 years or September 2013 (median/maximum follow-up 4.8/15.2 years) through linkage to the Spanish National Death Index. Detected depression was defined at baseline as a physician's diagnosis or antidepressant use, undetected depression as significant depressive symptoms (score of 4 or higher on the ten-item version of the Geriatric Depression Scale) without documented diagnosis or treatment, and no depression as the absence of diagnosis, treatment, and symptoms. Constant and age-dependent hazard ratios for mortality comparing detected and undetected depression with no depression were estimated using Cox models, and absolute years of life gained and lost using Weibull models.Results.The baseline prevalences of detected and undetected depression were 25.9 and 18.8%, respectively. A total of 499 participants died during 3575 person-years of follow-up. In models adjusted for age, sex, type of facility, number of chronic conditions, and functional dependency, overall depression was not associated with long-term all-cause mortality (hazard ratio 0.87, 95% confidence interval (CI): 0.70–1.08). However, compared with no depression, detected depression showed lower mortality (hazard ratio 0.63, 95% CI: 0.46–0.86), while undetected depression registered higher, not statistically significant, mortality (hazard ratio 1.35, 95% CI: 0.98–1.86). The median life expectancy increased by 1.8 years (95% CI: −3.1 to 6.7 years) in residents with detected depression and decreased by 6.3 years (95% CI: 2.6–10.1 years) in those undetected. Results were more marked in women than men and they were robust to the exclusion of antidepressants from the definition of depression and also to the use of a stricter cut-off for the presence of depressive symptoms.Conclusions.The long-term mortality risk associated with depression in nursing homes depends on its detection status, with better prognosis in residents with detected depression and worse in those undetected. The absolute impact of undetected depressive symptoms in terms of life expectancy can be prominent.

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Prestroke Physical Activity and Adverse Health Outcomes After Stroke in the Atherosclerosis Risk in Communities Study

Stroke ◽

10.1161/strokeaha.120.032695 ◽

2021 ◽

Author(s):

Mauro F. F. Mediano ◽

Yejin Mok ◽

Josef Coresh ◽

Anna Kucharska-Newton ◽

Priya Palta ◽

...

Keyword(s):

Lower Risk ◽

Hazard Ratio ◽

Atherosclerosis Risk In Communities ◽

Adverse Health Outcomes ◽

Mortality Hazard ◽

Atherosclerosis Risk ◽

All Cause Mortality ◽

Mortality Hazard Ratio

Background and Purpose: The association of physical activity (PA) before stroke (prestroke PA) with long-term prognosis after stroke is still unclear. We examined the association of prestroke PA with adverse health outcomes in the ARIC study (Atherosclerosis Risk in Communities). Methods: We included 881 participants with incident stroke occurring between 1993 and 1995 (visit 3) and December 31, 2016. Follow-up continued until December 31, 2017 to allow for at least 1-year after incident stroke. Prestroke PA was assessed using a modified version of the Baecke questionnaire in 1987 to 1989 (visit 1) and 1993 to 1995 (visit 3), evaluating PA domains (work, leisure, and sports) and total PA. We used Cox proportional hazards models to quantify the association between tertiles of accumulated prestroke PA levels over the 6-year period between visits 1 and 3 and mortality, risk of cardiovascular disease, and recurrent stroke after incident stroke. Results: During a median follow-up of 3.1 years after incident stroke, 676 (77%) participants had adverse outcomes. Highest prestroke total PA was associated with decreased risks of all-cause mortality (hazard ratio, 0.78 [95% CI, 0.63–0.97]) compared with lowest tertile. In the analysis by domain-specific PA, highest levels of work PA were associated with lower risk for all-cause (hazard ratio, 0.77 [95% CI, 0.62–0.96]) and cardiovascular mortality (hazard ratio, 0.45 [95% CI, 0.29–0.70]), and highest levels of leisure PA were associated with lower all-cause mortality (hazard ratio, 0.72 [95% CI, 0.58–0.89]) compared with lowest tertile of PA. No significant associations for sports PA were observed. Conclusions: Higher levels of total prestroke PA as well as work and leisure PA were associated with lower risk of mortality after incident stroke. Public health strategies to increase lifetime PA should be encouraged to decrease long-term mortality after stroke.

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When Is Higher Neuroticism Protective Against Death? Findings From UK Biobank

Psychological Science ◽

10.1177/0956797617709813 ◽

2017 ◽

Vol 28 (9) ◽

pp. 1345-1357 ◽

Cited By ~ 20

Author(s):

Catharine R. Gale ◽

Iva Čukić ◽

G. David Batty ◽

Andrew M. McIntosh ◽

Alexander Weiss ◽

...

Keyword(s):

Confidence Interval ◽

Hazard Ratio ◽

Lower Mortality ◽

Uk Biobank ◽

Self Rated Health ◽

Mortality Hazard ◽

All Cause Mortality ◽

Personality Facets ◽

External Causes ◽

Mortality Hazard Ratio

We examined the association between neuroticism and mortality in a sample of 321,456 people from UK Biobank and explored the influence of self-rated health on this relationship. After adjustment for age and sex, a 1- SD increment in neuroticism was associated with a 6% increase in all-cause mortality (hazard ratio = 1.06, 95% confidence interval = [1.03, 1.09]). After adjustment for other covariates, and, in particular, self-rated health, higher neuroticism was associated with an 8% reduction in all-cause mortality (hazard ratio = 0.92, 95% confidence interval = [0.89, 0.95]), as well as with reductions in mortality from cancer, cardiovascular disease, and respiratory disease, but not external causes. Further analyses revealed that higher neuroticism was associated with lower mortality only in those people with fair or poor self-rated health, and that higher scores on a facet of neuroticism related to worry and vulnerability were associated with lower mortality. Research into associations between personality facets and mortality may elucidate mechanisms underlying neuroticism’s covert protection against death.

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Insulin Resistance as a Predictor of Cardiovascular Disease in Patients on peritoneal dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00037 ◽

2013 ◽

Vol 33 (4) ◽

pp. 411-418 ◽

Cited By ~ 21

Author(s):

Yun Li ◽

Lihua Zhang ◽

Yong Gu ◽

Chuanming Hao ◽

Tongying Zhu

Keyword(s):

Insulin Resistance ◽

Peritoneal Dialysis ◽

Independent Predictor ◽

Hazard Ratio ◽

Diabetic Patients ◽

Model Assessment ◽

Mortality Hazard ◽

Cv Disease ◽

The Impact ◽

Mortality Hazard Ratio

BackgroundInsulin resistance is associated with multiple risk factors for cardiovascular (CV) disease in the general population. Patients on peritoneal dialysis (PD) are more likely to develop insulin resistance. However, no evaluation of the impact of insulin resistance on CV disease morbidity or mortality in patients on PD has been performed.MethodsOur prospective cohort study included all non-diabetic patients on PD at our center ( n = 66). Insulin resistance was evaluated at baseline by the homeostasis model assessment method (HOMA-IR) using fasting glucose and insulin levels. The cohort was followed for up to 58 months (median: 41.3 months; interquartile range: 34.3 months). A multivariate Cox model was used to analyze the impact of insulin resistance on CV disease mortality.ResultsFourteen CV events occurred in the higher HOMA-IR group [IR-H (HOMA-IR values in the range 2.85 – 19.5), n = 33], but only one event occurred in the lower HOMA-IR group (IR-L (HOMA-IR values in the range 0.83 – 2.71), n = 33) during the follow-up period. Level of HOMA-IR was a significant predictor of CV events [risk ratio: 17.7; 95% confidence interval (CI): 2.10 to 149.5; p = 0.008]. In the IR-H group, 10 patients died (8 CV events), but in the IR-L group, only 4 patients died (1 CV event). Patients in the IR-H group experienced significantly higher CV mortality (hazard ratio: 9.02; 95% CI: 1.13 to 72.2; p = 0.04). Even after adjustments for age, systolic blood pressure, body mass index, C-reactive protein, triglycerides, resistin, and leptin, HOMA-IR remained an independent predictor of CV mortality (hazard ratio: 14.8; 95% CI: 1.22 to 179.1; p = 0.03).ConclusionsInsulin resistance assessed using HOMA-IR was an independent predictor of CV morbidity and mortality in a cohort of nondiabetic patients on PD. Insulin resistance is a modifiable risk factor; the reduction of insulin resistance may reduce CV risk and improve survival in this group of patients.

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Plasma volume status predicts prognosis in patients with acute heart failure syndromes

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617690889 ◽

2017 ◽

Vol 7 (4) ◽

pp. 330-338 ◽

Cited By ~ 22

Author(s):

Akiomi Yoshihisa ◽

Satoshi Abe ◽

Yu Sato ◽

Shunsuke Watanabe ◽

Tetsuro Yokokawa ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Plasma Volume ◽

Hazard Ratio ◽

Volume Status ◽

Cardiac Events ◽

All Cause Mortality ◽

Acute Heart Failure Syndromes ◽

Mortality Hazard Ratio ◽

Ideal Plasma

Background: The intravascular compartment is known as the plasma volume, and the extravascular compartment represents fluid within the interstitial space. Plasma volume expansion is a major symptom of heart failure. The aim of the current study was to investigate the impact of plasma volume status on the prognosis of acute heart failure syndromes. Methods and results: We analyzed 1115 patients with acute heart failure syndromes who were admitted to our hospital. These patients were divided into three groups based on their plasma volume status at admission: first tertile (plasma volume status <41.9%, n = 371), second tertile (41.9%⩽ plasma volume status <49.0%, n = 372), and third tertile (49.0%⩽ plasma volume status, n = 372). Plasma volume status was defined as follows: actual plasma volume = (1 − hematocrit) × [ a + ( b × body weight)] ( a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal plasma volume = c × body weight ( c=39 in males and c=40 in females); and plasma volume status = [(actual plasma volume − ideal plasma volume)/ideal plasma volume] × 100 (%). In the Kaplan–Meier analysis, all-cause mortality, cardiac mortality and cardiac events increased progressively from the first to third tertile ( p <0.001, respectively). In the Cox proportional hazard analysis, after adjusting for potential confounding factors, plasma volume status was an independent predictor of all-cause mortality (hazard ratio 1.429, p < 0.001), cardiac mortality (hazard ratio 1.416, p = 0.001) and cardiac events (hazard ratio 1.207, p = 0.004). Conclusion: Increased congestion is associated with increased morbidity and mortality in heart failure patients. Plasma volume status, which represents intravascular compartment and congestion, can identify poor prognosis in patients with acute heart failure syndromes.

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Quality of Life and Mortality after Craniotomy for Brain Tumor Removal: A South Korean Nationwide Cohort Study

10.21203/rs.3.rs-665140/v1 ◽

2021 ◽

Author(s):

Tak Kyu Oh ◽

In-Ae Song ◽

Ji-Eyon Kwon ◽

Solyi Lee ◽

Hey-ran Choi ◽

...

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Brain Tumor ◽

Confidence Interval ◽

Tumor Removal ◽

Acquired Disability ◽

Mortality Hazard ◽

All Cause Mortality ◽

Mortality Hazard Ratio

Abstract PurposeWe aimed to investigate the prevalence of quality-of-life deterioration and associated factors in patients who underwent craniotomies for brain tumor removal. Additionally, we examined whether deteriorating quality of life after surgery might affect mortality. MethodsAs a national population-based cohort study, data were extracted from the National Health Insurance Service database of South Korea. Adult patients (≥18 years old) who underwent craniotomy for excision of brain tumors after diagnosis of malignant brain tumor between January 1, 2011, and December 31, 2017, were included in this study. ResultsA total of 4,852 patients were included in the analysis. Among them, 2,273 patients (46.9%) experienced a deterioration in quality of life after surgery. Specifically, 595 (12.3%) lost their jobs, 1,329 (27.4%) experienced decreased income, and 844 (17.4%) patients had newly acquired disabilities. In the multivariable Cox regression model, a lower quality of life was associated with a 1.41-fold higher 2-year all-cause mortality (hazard ratio: 1.41, 95% confidence interval: 1.27–1.57; P<0.001). Specifically, newly acquired disability was associated with 1.80-fold higher 2-year all-cause mortality (hazard ratio: 1.80, 95% confidence interval: 1.59–2.03; P<0.001), while loss of job (P=0.353) and decreased income (P=0.599) were not significantly associated.ConclusionsAt one-year follow-up, approximately half the patients who participated in this study experienced a deterioration in the quality-of-life measures of unemployment, decreased income, and newly acquired disability after craniotomy for excision of brain tumors. Newly acquired disability was associated with increased 2-year all-cause mortality.

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Effect of Renin-Angiotensin-Aldosterone System Inhibitors on Short-Term Mortality After Sepsis

Hypertension ◽

10.1161/hypertensionaha.119.13197 ◽

2020 ◽

Vol 75 (2) ◽

pp. 483-491 ◽

Cited By ~ 9

Author(s):

Wan-Ting Hsu ◽

Brandon Patrick Galm ◽

Gregory Schrank ◽

Tzu-Chun Hsu ◽

Shih-Hao Lee ◽

...

Keyword(s):

Propensity Score ◽

Meta Analysis ◽

Hazard Ratio ◽

Short Term ◽

Renin Angiotensin Aldosterone System ◽

Renin Angiotensin ◽

Mortality Hazard ◽

Short Term Mortality ◽

Raas Inhibitors ◽

Mortality Hazard Ratio

Antagonists of the renin-angiotensin-aldosterone system (RAAS), including ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers), may prevent organ failure. We, therefore, investigated whether specific RAAS inhibitors are associated with reduced mortality in patients with sepsis.We conducted a population-based retrospective cohort study using multivariable propensity score–based regression to control for differences among patients using different RAAS inhibitors. A multivariable-adjusted Cox proportional-hazards regression model was used to determine the association between RAAS inhibitors and sepsis outcomes. To directly compare ACEI users, ARB users, and nonusers, a 3-way propensity score matching approach was performed. Results were pooled with previous evidence via a random-effects meta-analysis. A total of 52 727 patients were hospitalized with sepsis, of whom 7642 were prescribed an ACEI and 4237 were prescribed an ARB. Using propensity score–matched analyses, prior ACEI use was associated with decreased 30-day mortality (hazard ratio, 0.84 [95% CI, 0.75–0.94]) and 90-day mortality (hazard ratio, 0.83 [95% CI, 0.75–0.92]) compared with nonuse. Prior ARB use was associated with an improved 90-day survival (hazard ratio, 0.88 [95% CI, 0.83–0.94]). These results persisted in sensitivity analyses focusing on patients without cancer and patients with hypertension. By contrast, no beneficial effect was found for antecedent β-blockers exposure (hazard ratio, 0.99 [95% CI, 0.94–1.05]). The pooled estimates obtained from the meta-analysis was 0.71 (95% CI, 0.58–0.87) for prior use of ACEI/ARB.The short-term mortality after sepsis was substantially lower among those who were already established on RAAS inhibitor treatment when sepsis occurred.

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