脓毒性休克中活化蛋白 C：倾向匹配分析。
Activated protein C in septic shock: a propensity-matched analysis.
机构信息
St. John's Mercy Medical Center/St Louis University, 621 S New Ballas Rd., Suite 4006B, St. Louis, MO 63141, USA.
出版信息
Crit Care. 2011;15(2):R89. doi: 10.1186/cc10089. Epub 2011 Mar 8.
INTRODUCTION
The use of human recombinant activated protein C (rhAPC) for the treatment of severe sepsis remains controversial despite multiple reported trials. The efficacy of rhAPC remains a matter of dispute. We hypothesized that patients with septic shock who were treated with rhAPC had an improved in-hospital mortality compared to patients with septic shock with similar acuity who did not receive rhAPC.
METHODS
This retrospective cohort study was completed at a large university-affiliated hospital. All patients with septic shock admitted to a 50-bed ICU between July 2003 and February 2009 were included. Patients were treated according to sepsis management guidelines.
RESULTS
A total of 563 septic shock patients were included (110 received rhAPC and 453 did not). Treated and untreated groups were matched in patient characteristics, comorbidities, and physiologic variables in a 1:1 propensity-matched analysis (108 received rhAPC, 108 did not). Mean Acute Physiology And Chronic Health Evaluation II (APACHE II) scores were 24.5 for the matched treated and 23.9 for the matched untreated group (P = 0.54). Receipt of rhAPC was associated with reduced in-hospital mortality (35.2% vs. 53.8%, P = 0.005), similar mean days on vasopressors (2 vs. 2, P = 0.90), similar mean days on mechanical ventilation (9 vs. 8.7, P = 0.80), similar mean length of ICU stay in days (11.0 vs. 11.3, P = 0.90), and similar mean length of hospital stay in days (19.5 vs 27, P = 0.11). No patients in either group had intracranial bleeding; differences in gastrointestinal bleeding and transfusion requirements were not statistically significant.
CONCLUSIONS
Patients in our institution with septic shock who were treated with rhAPC had a reduced in-hospital mortality compared with patients with septic shock with similar acuity who were not treated with rhAPC. In addition, time on mechanical ventilation, time on vasopressors, lengths of stay and bleeding complications did not differ between the groups.
引言
尽管有多项报道的试验，但人重组活化蛋白 C（rhAPC）在治疗严重败血症中的应用仍存在争议。rhAPC 的疗效仍然存在争议。我们假设，与未接受 rhAPC 治疗的类似严重程度的败血症休克患者相比，接受 rhAPC 治疗的败血症休克患者的住院死亡率有所改善。
方法
这项回顾性队列研究是在一家大型大学附属医院完成的。纳入 2003 年 7 月至 2009 年 2 月期间入住 50 张 ICU 病床的所有败血症休克患者。患者按照败血症管理指南进行治疗。
结果
共纳入 563 例败血症休克患者（110 例接受 rhAPC 治疗，453 例未接受）。在 1:1 倾向匹配分析中，治疗组和未治疗组在患者特征、合并症和生理变量方面匹配（108 例接受 rhAPC 治疗，108 例未接受）。匹配的治疗组和未治疗组的平均急性生理学和慢性健康评估 II（APACHE II）评分分别为 24.5 和 23.9（P=0.54）。接受 rhAPC 治疗与降低住院死亡率相关（35.2%比 53.8%，P=0.005），使用血管加压药的平均天数相似（2 天比 2 天，P=0.90），使用机械通气的平均天数相似（9 天比 8.7 天，P=0.80），入住 ICU 的平均天数相似（11.0 天比 11.3 天，P=0.90），住院天数相似（19.5 天比 27 天，P=0.11）。两组均无颅内出血患者；胃肠道出血和输血需求的差异无统计学意义。
结论
与未接受 rhAPC 治疗的类似严重程度的败血症休克患者相比，本机构接受 rhAPC 治疗的败血症休克患者的住院死亡率降低。此外，两组之间的机械通气时间、血管加压药使用时间、住院时间和出血并发症无差异。
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