Prior use of Angiotensin converting enzyme inhibitors (ACEi) or Angiotensin II receptor blockers (ARBs) and clinical outcomes of sepsis and septic shock: A systematic review and meta-analysis.

Sepsis and septic shock are life-threatening conditions which are associated with high mortality and considerable healthcare costs. The association between prior angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs) use and outcomes following sepsis is elusive. The aim of this study is to evaluate the role of the prior use of ACEi and ARBs and outcomes post sepsis and septic shock. A relevant literature review was performed in four databases from inception until July 2022. Independent reviewers first screened the title, abstract and full text, then data extraction and analysis were performed. One post-hoc analysis of a trial and six retrospective cohort studies were included in this review. There were 22% lower odds of in-hospital/30-day mortality among patients who have used ACEi/ARBs in the past, (23.83% vs. 37.20%; OR 0.78, 95% CI 0.64-0.96) as well as reduced 90-day mortality (OR 0.80, 95% CI 0.69-0.92). ACEi/ARBs users were found to have 31% lesser odds of developing acute kidney injury (AKI) as compared to non-users (OR 0.69, 95% CI 0.63-0.76). There was no significant difference in the length of hospital stay (MD 1.26, 95% CI -7.89 to 10.42), need for renal replacement therapy (OR 0.71, 95% CI 0.13- 3.92), mechanical ventilation (OR 1.10, 95% CI 0.88-1.37) or use of vasopressors (OR 1.21, 95% CI 0.91-1.61). Based on this analysis, prior use of ACEi/ARBs lowers the risk of mortality and adverse renal events in patients with sepsis and septic shock.