Massachusetts Institute of Technology, Cambridge, MA.
Beth Israel Deaconess Medical Center, Boston, MA.
Chest. 2014 Apr;145(4):745-752. doi: 10.1378/chest.13-1722.
Observational studies have found an increased risk of adverse effects such as hemorrhage, stroke, and increased mortality in patients taking selective serotonin reuptake inhibitors (SSRIs). The impact of prior use of these medications on outcomes in critically ill patients has not been previously examined. We performed a retrospective study to determine if preadmission use of SSRIs or serotonin norepinephrine reuptake inhibitors (SNRIs) is associated with mortality differences in patients admitted to the ICU.
The retrospective study used a modifiable data mining technique applied to the publicly available Multiparameter Intelligent Monitoring in Intensive Care (MIMIC) 2.6 database. A total of 14,709 patient records, consisting of 2,471 in the SSRI/SNRI group and 12,238 control subjects, were analyzed. The study outcome was in-hospital mortality.
After adjustment for age, Simplified Acute Physiology Score, vasopressor use, ventilator use, and combined Elixhauser score, SSRI/SNRI use was associated with significantly increased in-hospital mortality (OR, 1.19; 95% CI, 1.02-1.40; P=.026). Among patient subgroups, risk was highest in patients with acute coronary syndrome (OR, 1.95; 95% CI, 1.21-3.13; P=.006) and patients admitted to the cardiac surgery recovery unit (OR, 1.51; 95% CI, 1.11-2.04; P=.008). Mortality appeared to vary by specific SSRI, with higher mortalities associated with higher levels of serotonin inhibition.
We found significant increases in hospital stay mortality among those patients in the ICU taking SSRI/SNRIs prior to admission as compared with control subjects. Mortality was higher in patients receiving SSRI/SNRI agents that produce greater degrees of serotonin reuptake inhibition. The study serves to demonstrate the potential for the future application of advanced data examination techniques upon detailed (and growing) clinical databases being made available by the digitization of medicine.
观察性研究发现，服用选择性 5-羟色胺再摄取抑制剂（SSRIs）的患者出血、中风和死亡率增加的风险增加。先前使用这些药物对重症患者结局的影响尚未被研究过。我们进行了一项回顾性研究，以确定在 ICU 入院的患者中，SSRIs 或 5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）的预先使用是否与死亡率差异相关。
这项回顾性研究使用了一种可修改的数据挖掘技术，应用于公开的多参数智能监护重症监护（MIMIC）2.6 数据库。共分析了 14709 例患者记录，其中 SSRIs/SNRIs 组 2471 例，对照组 12238 例。研究结果为住院死亡率。
在调整年龄、简化急性生理学评分、血管加压素使用、呼吸机使用和联合 Elixhauser 评分后，SSRIs/SNRIs 的使用与住院死亡率显著增加相关（比值比，1.19；95%置信区间，1.02-1.40；P=.026）。在患者亚组中，急性冠状动脉综合征患者的风险最高（比值比，1.95；95%置信区间，1.21-3.13；P=.006），心脏手术恢复单元入院的患者风险最高（比值比，1.51；95%置信区间，1.11-2.04；P=.008）。死亡率似乎因特定的 SSRIs 而异，与更高的血清素抑制水平相关的死亡率更高。
与对照组相比，我们发现 ICU 入院前服用 SSRIs/SNRIs 的患者的住院死亡率显著增加。服用 SSRIs/SNRI 药物导致更高程度的血清素再摄取抑制的患者死亡率更高。这项研究证明了在医学数字化提供的详细（且不断增加）临床数据库的基础上，未来应用先进的数据检查技术的潜力。
