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补钙可改善重症监护病房患者的临床结局:基于大型临床数据库MIMIC-II的倾向评分匹配分析

Calcium supplementation improves clinical outcome in intensive care unit patients: a propensity score matched analysis of a large clinical database MIMIC-II.

作者信息

Zhang Zhongheng, Chen Kun, Ni Hongying

机构信息

Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, 351#, Mingyue Road, Jinhua, Zhejiang 321000 China.

出版信息

Springerplus. 2015 Oct 13;4:594. doi: 10.1186/s40064-015-1387-7. eCollection 2015.

Abstract

UNLABELLED

Observational studies have linked hypocalcemia with adverse clinical outcome in critically ill patients. However, calcium supplementation has never been formally investigated for its beneficial effect in critically ill patients. To investigate whether calcium supplementation can improve 28-day survival in adult critically ill patients. Secondary analysis of a large clinical database consisting over 30,000 critical ill patients was performed. Multivariable analysis was performed to examine the independent association of calcium supplementation and 28-day morality. Furthermore, propensity score matching technique was employed to investigate the role of calcium supplementation in improving survival.

INTERVENTION

none. Primary outcome was the 28-day mortality. 90-day mortality was used as secondary outcome. A total of 32,551 adult patients, including 28,062 survivors and 4489 non-survivors (28-day mortality rate: 13.8 %) were included. Calcium supplementation was independently associated with improved 28-day mortality after adjusting for confounding variables (hazard ratio: 0.51; 95 % CI 0.47-0.56). Propensity score matching was performed and the after-matching cohort showed well balanced covariates. The results showed that calcium supplementation was associated with improved 28- and 90-day mortality (p < 0.05 for both Log-rank test). In adult critically ill patients, calcium supplementation during their ICU stay improved 28-day survival. This finding supports the use of calcium supplementation in critically ill patients.

摘要

未标注

观察性研究已将低钙血症与危重症患者的不良临床结局联系起来。然而,钙剂补充对危重症患者有益作用的研究从未正式开展过。为研究钙剂补充能否改善成年危重症患者28天生存率。对一个包含超过30000例危重症患者的大型临床数据库进行了二次分析。进行多变量分析以检验钙剂补充与28天死亡率之间的独立关联。此外,采用倾向评分匹配技术研究钙剂补充在改善生存率方面的作用。

干预措施

无。主要结局为28天死亡率。90天死亡率用作次要结局。共纳入32551例成年患者,包括28062例幸存者和4489例非幸存者(28天死亡率:13.8%)。在调整混杂变量后,钙剂补充与改善28天死亡率独立相关(风险比:0.51;95%可信区间0.47 - 0.56)。进行了倾向评分匹配,匹配后的队列显示协变量平衡良好。结果表明,钙剂补充与改善28天和90天死亡率相关(对数秩检验均P < 0.05)。在成年危重症患者中,入住重症监护病房期间补充钙剂可改善28天生存率。这一发现支持在危重症患者中使用钙剂补充。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e6d1/4627965/af604a2a1365/40064_2015_1387_Fig1_HTML.jpg

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