钙通道阻滞剂的既往使用与脓毒症重症患者死亡率降低相关：一项前瞻性观察性研究。

Prior Use of Calcium Channel Blockers Is Associated With Decreased Mortality in Critically Ill Patients With Sepsis: A Prospective Observational Study.

作者信息

Wiewel Maryse A, van Vught Lonneke A, Scicluna Brendon P, Hoogendijk Arie J, Frencken Jos F, Zwinderman Aeilko H, Horn Janneke, Cremer Olaf L, Bonten Marc J, Schultz Marcus J, van der Poll Tom

机构信息

1Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 2The Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 3Department of Clinical Epidemiology, Bioinformatics, and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 4Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 5Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 6Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. 7Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. 8Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands.

出版信息

Crit Care Med. 2017 Mar;45(3):454-463. doi: 10.1097/CCM.0000000000002236.

DOI:10.1097/CCM.0000000000002236

PMID:28079604

Abstract

OBJECTIVES

Experimental studies suggest that calcium channel blockers can improve sepsis outcome. The aim of this study was to determine the association between prior use of calcium channel blockers and the outcome of patients admitted to the ICU with sepsis.

DESIGN

A prospective observational study.

SETTING

The ICUs of two tertiary care hospitals in the Netherlands.

PATIENTS

In total, 1,060 consecutive patients admitted with sepsis were analyzed, 18.6% of whom used calcium channel blockers.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Considering large baseline differences between calcium channel blocker users and nonusers, a propensity score matched cohort was constructed to account for differential likelihoods of receiving calcium channel blockers. Fifteen plasma biomarkers providing insight in key host responses implicated in sepsis pathogenesis were measured during the first 4 days after admission. Severity of illness over the first 24 hours, sites of infection and causative pathogens were similar in both groups. Prior use of calcium channel blockers was associated with improved 30-day survival in the propensity-matched cohort (20.2% vs 32.9% in non-calcium channel blockers users; p = 0.009) and in multivariate analysis (odds ratio, 0.48; 95% CI, 0.31-0.74; p = 0.0007). Prior calcium channel blocker use was not associated with changes in the plasma levels of host biomarkers indicative of activation of the cytokine network, the vascular endothelium and the coagulation system, with the exception of antithrombin levels, which were less decreased in calcium channel blocker users.

CONCLUSIONS

Prior calcium channel blocker use is associated with reduced mortality in patients following ICU admission with sepsis.

摘要

目的

实验研究表明钙通道阻滞剂可改善脓毒症的预后。本研究旨在确定既往使用钙通道阻滞剂与入住重症监护病房（ICU）的脓毒症患者预后之间的关联。

设计

一项前瞻性观察性研究。

地点

荷兰两家三级护理医院的ICU。

患者

总共分析了1060例连续入院的脓毒症患者，其中18.6%使用了钙通道阻滞剂。

干预措施

无。

测量指标及主要结果

考虑到钙通道阻滞剂使用者和非使用者之间存在较大的基线差异，构建了倾向评分匹配队列以解释接受钙通道阻滞剂的不同可能性。在入院后的前4天内测量了15种血浆生物标志物，以深入了解脓毒症发病机制中关键的宿主反应。两组患者在最初24小时内的疾病严重程度、感染部位和致病病原体相似。在倾向评分匹配队列中，既往使用钙通道阻滞剂与30天生存率提高相关（非钙通道阻滞剂使用者为20.2%，钙通道阻滞剂使用者为32.9%；p = 0.009），在多变量分析中也是如此（优势比为0.48；95%可信区间为0.31 - 0.74；p = 0.0007）。除抗凝血酶水平外，既往使用钙通道阻滞剂与指示细胞因子网络、血管内皮和凝血系统激活的宿主生物标志物血浆水平变化无关，钙通道阻滞剂使用者的抗凝血酶水平下降较少。