Renin-Angiotensin-Aldosterone Medication Use and Outcomes in Injured Patients Receiving Blood.

INTRODUCTION

The modulation of the renin-angiotensin-aldosterone system in the form of angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin II receptor blockers (ARBs) is associated with improved mortality in sepsis. Furthermore, early blood transfusions following injury are associated with improved patient outcomes. However, the use of ACE-I/ARB medications has yet to be studied in those receiving blood transfusions. The objective of this study is to evaluate the use of preinjury ACE-I/ARB exposure in patients receiving blood transfusions following injury.

METHODS

Patients who underwent any blood product transfusion as part of their resuscitation and received preinjury ACE-I/ARB medications were compared to those who did not receive preinjury ACE-I/ARB. Demographics, complication rates, blood product transfusion volumes, and mortality were evaluated. Univariate and multivariable analyses were conducted to identify independent predictors of mortality.

RESULTS

In the study period, 1013 patients received a transfusion as part of their resuscitation. Of these, 220 patients (21.7%) had taken ACE-I/ARB medications prior to injury. Patients who were exposed to a preinjury ACE-I/ARB exhibited a lower 24-h mortality rate compared to those who were not (10% versus 17.9%, P = 0.01). Even after adjusting for imbalances, age, blunt mechanism, systolic blood pressure, heart rate, international normalized ratio, and Injury Severity Score, preinjury use of ACE-I/ARB remained a significant independent predictor of early mortality following multiple logistic regression. Preinjury use of ACE-I/ARB was associated with an increased risk of developing acute kidney injury (odds ratio: 2.57; 95% confidence interval: 1.29-5.12).

CONCLUSIONS

In injured patients who received blood product resuscitation following trauma, preinjury use of medications that modulate the renin-angiotensin-aldosterone system was associated with improved short-term outcomes.