Hsu W.-T.Galm B.P.Schrank G.Hsu T.-C.Lee S.-H.Park J.Y.CHIEN-CHANG LEE2020-03-242020-03-2420201524-4563https://scholars.lib.ntu.edu.tw/handle/123456789/478184Antagonists 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. ? 2020 Lippincott Williams and Wilkins. All rights reserved.[SDGs]SDG3angiotensin receptor antagonist; dipeptidyl carboxypeptidase inhibitor; aged; clinical trial; drug effect; epidemiology; female; follow up; health survey; human; male; metabolism; middle aged; mortality; multicenter study; procedures; propensity score; renin angiotensin aldosterone system; retrospective study; risk factor; sepsis; survival rate; Taiwan; Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Female; Follow-Up Studies; Humans; Male; Middle Aged; Population Surveillance; Propensity Score; Renin-Angiotensin System; Retrospective Studies; Risk Factors; Sepsis; Survival Rate; Taiwanjournal article10.1161/HYPERTENSIONAHA.119.13197318389052-s2.0-85077761809