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哥伦比亚波哥大重症监护病房收治的自身免疫性疾病患者死亡率的相关因素

Factors Associated with Mortality in Patients with Autoimmune Diseases Admitted to the Intensive Care Unit in Bogota, Colombia.

作者信息

Carrizosa Jorge Armando, Aponte Jorge, Cartagena Diego, Cervera Ricard, Ospina Maria Teresa, Sanchez Alexander

机构信息

Fundacion Santa Fe de Bogota, Department of Critical Care Medicine , Bogotá , Colombia.

Universidad de la Sabana, Resident of Internal Medicine , Bogotá , Colombia.

出版信息

Front Immunol. 2017 Mar 23;8:337. doi: 10.3389/fimmu.2017.00337. eCollection 2017.

Abstract

Patients with autoimmune diseases (ADs) are a challenge for the intensivist; it is hard to differentiate among infection, disease activity, and combinations of both, leading to high mortality. This study is a retrospective analysis of 124 critically ill patients admitted to the intensive care unit (ICU) in a university hospital between 2008 and 2016. Bivariate case-control analysis was performed, using patients who died as cases; later, analysis using a logistic regression model with variables that were associated with mortality was conducted. Four variables were consistently associated with mortality in the logistic regression model and had adequate prediction value (Hosmer and Lemeshow statistic = 0.760; Nagelkerke -squared = 0.494). The risk of death was found to be statistically associated with the following: shock at admission to ICU [odds ratio (OR): 7.56; 95% confidence interval (CI): 1.78-31.97,  = 0.006], hemoglobin level <8 g/dL (OR: 16.12; 95% CI: 3.35-77.52,  = 0.001), use of cytostatic agents prior to admission to the ICU (OR: 8.71; 95% CI: 1.23-61.5,  = 0.03), and low levels ofcomplement C3 (OR: 5.23; 95% CI: 1.28-21.35,  = 0.02). These variables can guide clinicians in the early identification of patients with AD with increased risk of death during hospitalization, leading to initial therapies seeking to improve survival. These results should be evaluated prospectively in future studies to establish their predictive power.

摘要

自身免疫性疾病(ADs)患者对重症监护医生来说是一项挑战;很难区分感染、疾病活动度以及两者的合并情况,这导致了高死亡率。本研究是对2008年至2016年期间在一所大学医院重症监护病房(ICU)收治的124例重症患者进行的回顾性分析。采用双变量病例对照分析,以死亡患者作为病例;随后,使用与死亡率相关的变量进行逻辑回归模型分析。在逻辑回归模型中有四个变量始终与死亡率相关且具有足够的预测价值(Hosmer和Lemeshow统计量=0.760;Nagelkerke平方=0.494)。发现死亡风险与以下因素在统计学上相关:入住ICU时休克[比值比(OR):7.56;95%置信区间(CI):1.78 - 31.97,P = 0.006]、血红蛋白水平<8 g/dL(OR:16.12;95% CI:3.35 - 77.52,P = 0.001)、入住ICU前使用细胞毒性药物(OR:8.71;95% CI:1.23 - 61.5,P = 0.03)以及补体C3水平低(OR:5.23;95% CI:1.28 - 21.35,P = 0.02)。这些变量可指导临床医生在住院期间早期识别AD死亡风险增加的患者,从而采取旨在提高生存率的初始治疗措施。这些结果应在未来研究中进行前瞻性评估,以确定其预测能力。

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