Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan.
Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
Crit Care Med. 2019 Feb;47(2):167-175. doi: 10.1097/CCM.0000000000003468.
To evaluate the ramifications of steroid use during postarrest care.
Retrospective observational population-based study enrolled patients during years 2004-2011 with 1-year follow-up.
Taiwan National Health Insurance Research Database.
Adult nontraumatic cardiac arrest patients in the emergency department, who survived to admission.
These patients were classified into the steroid and nonsteroid groups based on whether steroid was used or not during hospitalization. A propensity score was used to match patient underlying characteristics, steroid use prior to cardiac arrest, the vasopressors, and shockable rhythm during cardiopulmonary resuscitation, hospital level, and socioeconomic status.
There were 5,445 patients in each group after propensity score matching. A total of 4,119 patients (75.65%) in the steroid group died during hospitalization, as compared with 4,403 patients (80.86%) in the nonsteroid group (adjusted hazard ratio, 0.74; 95% CI, 0.70-0.77; p < 0.0001). The mortality rate at 1 year was significantly lower in the steroid group than in the nonsteroid group (83.54% vs 87.77%; adjusted hazard ratio, 0.73; 95% CI, 0.70-0.76; p < 0.0001). Steroid use during hospitalization was associated with survival to discharge, regardless of age, gender, underlying diseases (diabetes mellitus, chronic obstructive pulmonary disease, asthma), shockable rhythm, and steroid use prior to cardiac arrest.
In this retrospective observational study, postarrest steroid use was associated with better survival to hospital discharge and 1-year survival.
评估复苏后使用类固醇的后果。
回顾性观察性基于人群的研究，纳入 2004 年至 2011 年期间具有 1 年随访的急诊科成年非创伤性心搏骤停患者。
台湾全民健康保险研究数据库。
在急诊科存活至入院的接受心搏骤停治疗的成年非创伤性心搏骤停患者。
根据住院期间是否使用类固醇，将这些患者分为类固醇组和非类固醇组。使用倾向评分匹配患者的潜在特征、心搏骤停前使用类固醇、心肺复苏期间使用的血管加压素和可除颤节律、医院级别和社会经济状况。
在倾向评分匹配后，每组各有 5445 例患者。在类固醇组中，共有 4119 例（75.65%）患者在住院期间死亡，而非类固醇组中，共有 4403 例（80.86%）患者死亡（调整后的危险比，0.74；95%CI，0.70-0.77；p<0.0001）。类固醇组的 1 年死亡率明显低于非类固醇组（83.54%比 87.77%；调整后的危险比，0.73；95%CI，0.70-0.76；p<0.0001）。住院期间使用类固醇与出院时的存活有关，与年龄、性别、基础疾病（糖尿病、慢性阻塞性肺疾病、哮喘）、可除颤节律和心搏骤停前使用类固醇无关。
在这项回顾性观察性研究中，心搏骤停后使用类固醇与更好的出院存活率和 1 年存活率相关。
