Abstract
BackgroundRecent studies suggest that angiotensin-converting enzyme (ACE) inhibitors may have beneficial effects for patients at risk for some types of infections. We examined the effect of prior outpatient use of ACE inhibitors on mortality for patients hospitalized with community-acquired pneumonia.MethodsA retrospective cohort study conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of, had a chest x-ray consistent with, and had a discharge ICD-9 diagnosis of pneumonia. Subjects were excluded if they were "comfort measures only" or transferred from another acute care hospital. Subjects were considered to be on a medication if they were taking it at the time of presentation.ResultsData was abstracted on 787 subjects at the two hospitals. Mortality was 9.2% at 30-days and 13.6% at 90-days. At presentation 52% of subjects were low risk, 34% were moderate risk, and 14% were high risk. In the multivariable conditional logistic regression analysis, after adjusting for potential confounders, the use of ACE inhibitors at presentation (odds ratio 0.44, 95% confidence interval 0.22–0.89) was significantly associated with 30-day mortality.ConclusionPrior outpatient use of an ACE inhibitor was associated with decreased mortality in patients hospitalized with community-acquired pneumonia despite their use being associated with comorbid illnesses likely to contribute to increased mortality. Confirmatory studies are needed, as well as research to determine the mechanism(s) of this protective effect.
Highlights
Recent studies suggest that angiotensin-converting enzyme (ACE) inhibitors may have beneficial effects for patients at risk for some types of infections
We found that prior outpatient use of ACE inhibitors was associated with decreased 30-day mortality for subjects hospitalized with community-acquired pneumonia
Our findings provide further support to other studies that demonstrate that ACE inhibitor use is associated with decreased mortality for patients with pneumonia
Summary
Recent studies suggest that angiotensin-converting enzyme (ACE) inhibitors may have beneficial effects for patients at risk for some types of infections. BMC Pulmonary Medicine 2005, 5:12 http://www.biomedcentral.com/1471-2466/5/12 the armamentarium for treating community-acquired pneumonia in the last 20 years and no new classes of medications beyond antibiotics have been added since the 1950s. Other studies have demonstrated significant changes in systemic cytokine levels for subjects treated with ACE inhibitors [6,7,8]. These cytokines play an important role in host defense mechanisms for patients with community-acquired pneumonia but under certain conditions may lead to septic shock or acute respiratory distress syndrome (ARDS) [9,10,11]
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