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Risk of Sepsis and Mortality Among Patients With Chronic Obstructive Pulmonary Disease Treated With Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers

Lai, Chih-Cheng, MD1; Wang, Ya-Hui, PhD2; Wang, Cheng-Yi, MD, PhD3; Wang, Hao-Chien, MD, PhD4; Yu, Chong-Jen, MD, PhD4; Chen, Likwang, PhD5 on the behalf of Taiwan Clinical Trial Consortium for Respiratory Diseases (TCORE)

doi: 10.1097/CCM.0000000000003475
Online Clinical Investigations
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Objectives: This study aimed to compare the effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the risk and outcomes of sepsis in patients with chronic obstructive pulmonary disease.

Design: A retrospective study.

Setting: Taiwan’s National Health Insurance Research Database.

Patients: All patients with chronic obstructive pulmonary disease who received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for more than 90 days between 2000 and 2005 were recruited for this study. Pairwise matching (1:1) of the angiotensin-converting enzyme inhibitor and angiotensin receptor blocker groups resulted in two similar subgroups with 5,959 patients in each.

Interventions: None.

Measurements and Main Results: The primary outcome was sepsis, and the secondary outcome was death. The occurrence rate of sepsis was 3.67 per 100 person-years for the patients receiving angiotensin-converting enzyme inhibitors and 2.87 per 100 person-years for those receiving angiotensin receptor blockers. In addition, the patients receiving angiotensin-converting enzyme inhibitors had a higher risk of septic shock (adjusted hazard ratio, 1.45; 95% CI, 1.26–1.67) and mortality (adjusted hazard ratio, 1.31; 95% CI, 1.22–1.40) than those receiving angiotensin receptor blockers. No matter whether the patients had prior severe exacerbation before the index date, those receiving angiotensin-converting enzyme inhibitors had a higher risk of sepsis, septic shock, and mortality than those receiving angiotensin receptor blockers (all p < 0.001).

Conclusions: Angiotensin receptor blockers were associated with lower rates of sepsis and mortality than angiotensin-converting enzyme inhibitors in the patients with chronic obstructive pulmonary disease. The similar findings were also noted in subgroup analysis.

1Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.

2Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.

3Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.

4Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.

5Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.

Members of Taiwan Clinical Trial Consortium for Respiratory Diseases (TCORE) are listed in the Acknowledgments.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by grants from National Science Council (104-2314-B-002-185-MY2, 101-2325-B-002-064, 102-2325-B-002-087, 103-2325-B-002-027, 104-2325-B-002-035, 105-2325-B-002-030, 104-2314-B-567-002, 105-2314-B-567-001), and from National Health Research Institutes (intramural funding).

Dr. Cheng-Yi Wang disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: cywang@mospital.com

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