ACE-inhibitor therapy and survival among patients with multiorgan dysfunction syndrome (MODS) of cardiac and non-cardiac origin

Background: The multiple organ dysfunction syndrome (MODS) is the sequential failure of organ systems after a trigger event (e.g. cardiogenic shock) with a high mortality. ACE-inhibitors [ACEI] are known to ameliorate depressed autonomic function (heart rate variability [HRV]) to improve endothelial function and to decrease blood pressure. Modifications of these targets reduce major adverse cardiovascular events (patients with arterial hypertension, coronary artery disease and chronic heart failure). Our study aimed to characterize potential benefits of ACEI therapy in MODS patients.

Methods: 178 score-defined consecutive patients were enrolled. Inclusion criterion was an APACHE II score >or=20 at admission to the ICU. Patients were evaluated for ACEI therapy and followed for 28, 180 and 365 days. HRV was calculated according to the international standards.

Results: 68 patients received an ACEI during their ICU stay whereas 110 did not. The 28-day mortality was 55% (no ACEI treatment) vs. 22% (ACEI treatment, p<0.0001) and the 1-year mortality accounted for 75% (no ACEI) vs. 50% (ACEI), p<0.0001. There was no significant survival difference between early and later application of ACEI (after day 4), both application modes were characterized by an improved survival. MODS patients with ACEI treatment at admission had a better preserved HRV.

Conclusions: Our results may suggest that MODS patients with ACEI treatment may have lower short- and longer-term mortality. HRV was less attenuated when patients received ACEI therapy at admission. Consequently, effectiveness of ACEI therapy should be validated in a prospective trial.