Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2023; 11(36): 8498-8506
Published online Dec 26, 2023. doi: 10.12998/wjcc.v11.i36.8498
Impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on the mortality in sepsis: A meta-analysis
Deng-Can Yang, Jian Xu, Li Jian, Yi Yu
Deng-Can Yang, Department of Anesthesiology, The Central Hospital of Shaoyang, Shaoyang 422000, Hunan Province, China
Jian Xu, Li Jian, Department of Critical Care Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
Yi Yu, Department of Critical Care Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510006, Guangdong Province, China
Author contributions: Jian L and Yu Y designed the study; Yang DC conducted the literature search and data analysis; Xu J drafted the manuscript; Yu Y, Xu J, and Li J revised the manuscript; All authors read and approved the final manuscript.
Supported by the Guangdong Bureau of Traditional Chinese Medicine, No. 20232049; the Guangdong Bureau of Traditional Chinese Medicine, No. 20222065; the National Natural Science Foundation of China, No. 82104989.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi Yu, MD, Doctor, Department of Critical Care Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Daxuecheng Neihuan Xilu 55#, Guangzhou 510006, Guangdong Province, China. 1191922959@qq.com
Received: October 12, 2023
Peer-review started: October 12, 2023
First decision: November 28, 2023
Revised: November 29, 2023
Accepted: December 5, 2023
Article in press: December 5, 2023
Published online: December 26, 2023
Processing time: 71 Days and 7.1 Hours
Abstract
BACKGROUND

The effect of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on the mortality of patients with sepsis is not well characterized.

AIM

To elucidate the association between prior ACEI or ARB exposure and mortality in sepsis.

METHODS

The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for all studies of premorbid ACEI or ARB use and sepsis mortality until November 30 2019. Two reviewers independently assessed, selected, and abstracted data from studies reporting ACEIs or ARBs, sepsis, and mortality. The primary extracted data consisted of premorbid ACEI or ARB exposure, mortality, and general patient data. Two reviewers independently assessed the risk of bias and quality of evidence.

RESULTS

A total of six studies comprising 281238 patients with sepsis, including 49799 cases with premorbid ACEI or ARB exposure were eligible for analysis. Premorbid ACEIs or ARBs exposure decreased the 30-d mortality in patients with sepsis. Moreover, the use of ACEIs or ARBs was associated with approximately a 6% decreased risk of 30-d mortality.

CONCLUSION

The results of this systematic review suggest that ACEI or ARB exposure prior to sepsis may be associated with reduced mortality. Further high-quality cohort studies and molecular mechanism experiments are required to confirm our results.

Keywords: Sepsis; Mortality; Angiotensin-converting enzyme inhibitors; Angiotensin receptor blockers

Core Tip: To explore the potential relationship between the effect of premorbid angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) on mortality in sepsis. We extracted data from 6 studies. The results of this systematic review suggest that ACEI or ARB exposure prior to sepsis may be associated with reduced mortality. This may have some guiding significance for the treatment of coronavirus disease 2019.