Effect of angiotensin-converting enzyme inhibitors on the prognosis of sepsis-induced myocardial injury:a propensity score matching analysis
Chen Ying
Wei Shuxing
Wang Xiya
Wang Jinlong
Dong Hongmeng
Gao Zhenzhen
Guo Shubin
Mei Xue
Abstract：Objective To evaluate the effect of angiotensin-converting enzyme inhibitors(ACEI)on the 28-day all-cause mortality in the patients with sepsis-induced myocardial injury(SIMI)and to explore its potential therapeutic value.Methods Data for this study were sourced from the medical information mart for intensive care(MIMIC)-Ⅳ database.Eligible 2 450 SIMI patients were categorized into an ACEI group and a non-ACEI group.Propensity score matching(PSM)was performed to reduce baseline bias,with the primary outcome being 28-day all-cause mortality.The effects of ACEI on SIMI patients' prognosis were assessed by using Kaplan-Meier(K-M)curves,multivariate Cox regression analysis and subgroup analysis.External validation was conducted in 114 SIMI patients from Beijing Chaoyang Hospital,Capital Medical University.Results A total of 2 450 and 1 042 patients were included in the analysis before and after PSM adjustment,respectively.After PSM,the K-M curve showed that the 28-day mortality rate in the ACEI group was significantly lower than that in the non-ACEI group(P<0.001).Multivariate Cox regression analysis indicated that ACEI use was associated with a significantly lower 28-day mortality rate[hazard ratio(HR)=0.56,95%confidence interval(CI)0.42-0.74,P<0.001].Subgroup analysis showed that therapeutic effect of ACEI was consistent across different age,sex and underlying disease groups(interaction P>0.05).Additionally,there was no significant difference in the impact of different types of ACEI on the 28-day mortality rate(P>0.05).The external validation included114 SIMI patients.The K-M curve revealed a significant association between ACEI use and a reduction in 28-day cumulative mortality(P=0.001 7).Multivariate Cox regression analysis further confirmed the protective effect of ACEI,demonstrating a significant reduction in 28-day mortality(HR=0.22,95%CI 0.05-0.91,P=0.036).Conclusions The use of ACEI is significantly associated with a reduced 28-day all-cause mortality in SIMI patients,supporting its potential therapeutic value.
Keywords：Angiotensin-converting enzyme inhibitorSepsis-induced myocardial injuryIntensive care unitPropensity score matching28-day all-cause mortality
Publication Date：2025-04-10
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 316-322 )