Prehosp Emerg Care. 2020 Mar-Apr;24(2):196-203. doi: 10.1080/10903127.2019.1629134. Epub 2019 Jul 1.
Patients with acute illness who receive intravenous (IV) fluids prior to hospital arrival may have a lower in-hospital mortality. To better understand whether this is a direct treatment effect or epiphenomenon of downstream care, we tested the association between a prehospital fluid bolus and the change in inflammatory cytokines measured at prehospital and emergency department timepoints in a sample of non-trauma, non-cardiac arrest patients at risk for critical illness. In a prospective cohort study, we screened 4,013 non-trauma, non-cardiac arrest encounters transported by City of Pittsburgh Emergency Medical Services (EMS) to 2 hospitals from August 2013 to February 2014. In 345 patients, we measured prehospital biomarkers (IL-6, IL-10, and TNF) at 2 time points: the time of prehospital IV access placement by EMS and at ED arrival. We determined the relative change for marker as: ([ - ]/). We determined the risk-adjusted association between prehospital IV fluid bolus and relative change for each marker using multivariable linear regression. Among 345 patients, 88 (26%) received a prehospital IV fluid bolus and 257 (74%) did not. Compared to patients who did not receive prehospital fluids, median prehospital IL-6 was greater initially in subjects receiving a prehospital IV fluid bolus (22.3 [IQR 6.4-113] vs. 11.5 [IQR 5.5-47.6]). Prehospital IL-10 and TNF were similar in both groups (IL-10: 3.5 [IQR 2.2-25.6] vs. 3.0 [IQR 1.9-9.0]; TNF: 7.5 [IQR 6.4-10.4] vs. 6.9 [IQR 6.0-8.3]). After adjustment for demographics, illness severity, and prehospital transport time, we observed a relative decrease in IL-6 at hospital arrival in those receiving a prehospital fluid bolus (adjusted β = -10.0, 95% CI: -19.4, -0.6, = 0.04), but we did not detect a significant change in IL-10 ( = 0.34) or TNF ( = 0.53). Among non-trauma, non-cardiac arrest patients at risk for critical illness, a prehospital IV fluid bolus was associated with a relative decrease in IL-6, but not IL-10 or TNF.
在到达医院之前接受静脉（IV）补液的急性病患者住院死亡率可能较低。为了更好地了解这是直接治疗效果还是下游治疗的附带现象，我们在有发生危重病风险的非创伤性、非心搏骤停患者样本中，检测了院前补液与在院前和急诊时段测量的炎症细胞因子变化之间的关联。在一项前瞻性队列研究中，我们筛选了 2013 年 8 月至 2014 年 2 月期间由匹兹堡市紧急医疗服务（EMS）送往 2 家医院的 4013 例非创伤性、非心搏骤停的患者。在 345 例患者中，我们在 2 个时间点测量了院前生物标志物（IL-6、IL-10 和 TNF）：EMS 进行院前 IV 置管时和急诊科到达时。我们确定标记物的相对变化为：[（-）/]。我们使用多变量线性回归确定了院前 IV 液输注与每个标记物的相对变化之间的风险调整关联。在 345 例患者中，88 例（26%）接受了院前 IV 液输注，257 例（74%）未接受。与未接受院前补液的患者相比，接受院前 IV 液输注的患者的初始 IL-6 中位数较高（22.3[IQR 6.4-113] vs. 11.5[IQR 5.5-47.6]）。两组的院前 IL-10 和 TNF 相似（IL-10：3.5[IQR 2.2-25.6] vs. 3.0[IQR 1.9-9.0]；TNF：7.5[IQR 6.4-10.4] vs. 6.9[IQR 6.0-8.3]）。在校正人口统计学、疾病严重程度和院前转运时间后，我们观察到接受院前补液的患者在入院时的 IL-6 相对降低（调整β=-10.0，95%CI：-19.4，-0.6，=0.04），但我们未发现 IL-10（=0.34）或 TNF（=0.53）的显著变化。在有发生危重病风险的非创伤性、非心搏骤停患者中，院前 IV 液输注与 IL-6 的相对降低相关，但与 IL-10 或 TNF 无关。
