(539) Treatment With Corticosteroids in ACE Inhibitor-Induced Angioedema Does Not Affect Intubation Rates

Introduction: Steroids are commonly used in the management of angioedema, including angioedema secondary to ACE inhibitors. While treatment regimens including fresh frozen plasma, tranexamic acid, and other biologic therapies have demonstrated varying effects, it is unclear if corticosteroids affect outcomes in ACE inhibitor angioedema. We sought to identify if steroids have an effect on intubation rates and hospital length of stay in patients with ACE inhibitor induced angioedema.

Methods: We conducted a retrospective review of records from 108 patients diagnosed with ACE inhibitor related angioedema at a tertiary medical center between 2015 and 2021. We analyzed intubation rates (endotracheal or tracheostomy) and hospital lengths of stay. Statistical analyses were performed using two-sample t-tests for continuous variables, chi-squared tests for categorical variables, and ANOVA for regression analysis to determine the significance of the differences observed.

Results: One hundred and four (96.3%) patients with ACE inhibitor induced angioedema received steroids. Three patients (2.8%) received methylprednisolone, 48 patients (44.4%) received dexamethasone, and 52 patients (47.2 %) received prednisone. Steroid treatment did not appear to affect rates of intubation in patients with ACE-inhibitor induced angioedema (p=0.32). Hospital length of stay (LOS) was statistically different among patients who received methylprednisolone (mean LOS of 8 days, SD±7), dexamethasone (mean LOS 4 days, SD±6), and prednisone (mean LOS of 3 days, SD±5) vs those who received no steroids (mean LOS of 20 days, SD±13).

Conclusions: Treatment with steroids did not appear to affect rates of intubation in patients with ACE-inhibitor induced angioedema. Patients treated with prednisone had shorter hospital stays compared to those who received no steroids, methylprednisolone, or dexamethasone. Further study is needed to confirm these findings and better understand the mechanisms underlying this difference.