TBI: preinjury ACE inhibitors tied to excess mortality risk

  • Catapano JS & al.
  • Neurocrit Care
  • 11 Jun 2019

  • International Clinical Digest
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Takeaway

  • Patients with isolated severe traumatic brain injury (TBI) had higher risk of death if they had been using angiotensin-converting enzyme inhibitors (ACEIs) before their injury, but this risk was attenuated for those also using β-blockers.

Why this matters

Key results

  • Compared with nonusers, patients using ACEIs before their injury had twice the in-hospital mortality rate (10.4% vs 5%; P=.04).
  • Risk associated with ACEI use was more than tripled in multivariate stepwise logistic regression analysis (aOR, 3.66; P<.001>
  • Magnitude of increase exceeded that seen with Injury Severity Score of 16 or higher (aOR, 2.47; P=.04).
  • However, in a second analysis additionally including 98 patients receiving β-blockers before their injury, adverse effect of preinjury ACEI use was attenuated (aOR, 2.27; P=.05).

Study design

  • Retrospective cohort study of 600 patients age 40 years or older admitted to an academic level 1 trauma center over 5-year period with isolated severe TBI, not receiving β-blockers.
  • Main outcome: in-hospital mortality.
  • Funding: None.

Limitations

  • Residual and unmeasured confounding.
  • Causes of death not evaluated.