Lee Chien-Chang, Lee Meng-Tse Gabriel, Lee Wan-Chien, Lai Chih-Cheng, Chao Christin Chih-Ting, Hsu Wan-Ting Hsu, Chang Shy-Shin, Lee Matthew
1Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. 2Department of Intensive Care Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan. 3Canberra Hospital, ACT Health, Canberra, ACT, Australia. 4Department of Family Medicine, Taipei Medical University Hospital and School of Medicine, Taipei Medical University, Taipei, Taiwan. 5Medical Wisdom Consultants, Houston, TX.
Crit Care Med. 2017 Sep;45(9):1500-1508. doi: 10.1097/CCM.0000000000002550.
Use of calcium channel blockers has been found to improve sepsis outcomes in animal studies and one clinical study. This study determines whether the use of calcium channel blockers is associated with a decreased risk of mortality in patients with sepsis.
Population-based matched cohort study.
National Health Insurance Research Database of Taiwan.
Hospitalized severe sepsis patients identified from National Health Insurance Research Database by International Classification of Diseases, Ninth Revision, Clinical Modification codes.
None.
The association between calcium channel blocker use and sepsis outcome was determined by multivariate-adjusted Cox proportional hazard models and propensity score analysis. To examine the influence of healthy user bias, beta-blocker was used as an active comparator. Our study identified 51,078 patients with sepsis, of which, 19,742 received calcium channel blocker treatments prior to the admission. Use of calcium channel blocker was associated with a reduced 30-day mortality after propensity score adjustment (hazard ratio, 0.94; 95% CI, 0.89-0.99), and the beneficial effect could extend to 90-day mortality (hazard ratio, 0.95; 95% CI, 0.89-1.00). In contrast, use of beta-blocker was not associated with an improved 30-day (hazard ratio, 1.06; 95% CI, 0.97-1.15) or 90-day mortality (hazard ratio, 1.00; 95% CI, 0.90-1.11). On subgroup analysis, calcium channel blockers tend to be more beneficial to patients with male gender, between 40 and 79 years old, with a low comorbidity burden, and to patients with cardiovascular diseases, diabetes, or renal diseases.
In this national cohort study, preadmission calcium channel blocker therapy before sepsis development was associated with a 6% reduction in mortality when compared with patients who have never received calcium channel blockers.
在动物研究和一项临床研究中，已发现使用钙通道阻滞剂可改善脓毒症的预后。本研究旨在确定使用钙通道阻滞剂是否与脓毒症患者的死亡风险降低相关。
基于人群的匹配队列研究。
台湾国民健康保险研究数据库。
通过国际疾病分类第九版临床修订本代码从国民健康保险研究数据库中识别出的住院严重脓毒症患者。
无。
使用多变量调整的Cox比例风险模型和倾向评分分析来确定钙通道阻滞剂的使用与脓毒症预后之间的关联。为检验健康用户偏差的影响，使用β受体阻滞剂作为活性对照。我们的研究确定了51078例脓毒症患者，其中19742例在入院前接受了钙通道阻滞剂治疗。倾向评分调整后，使用钙通道阻滞剂与30天死亡率降低相关（风险比，0.94；95%置信区间，0.89 - 0.99），且有益效果可延伸至90天死亡率（风险比，0.95；95%置信区间，0.89 - 1.00）。相比之下，使用β受体阻滞剂与30天（风险比，1.06；95%置信区间，0.97 - 1.15）或90天死亡率改善无关（风险比，1.00；95%置信区间，0.90 - 1.11）。亚组分析显示，钙通道阻滞剂对男性、40至79岁、合并症负担低的患者以及患有心血管疾病、糖尿病或肾脏疾病的患者往往更有益。
在这项全国队列研究中，与从未接受过钙通道阻滞剂治疗的患者相比，脓毒症发生前入院前使用钙通道阻滞剂治疗可使死亡率降低6%。
