终末期肾病改变了院外心脏骤停后目标温度管理的效果。
End stage renal disease modifies the effect of targeted temperature management after out-of-hospital cardiac arrest.
机构信息
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Emergency Medicine, Seoul National University College of Medicine, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
出版信息
Am J Emerg Med. 2020 Nov;38(11):2283-2290. doi: 10.1016/j.ajem.2019.09.027. Epub 2019 Nov 18.
INTRODUCTION
Kidney function can affect the permeability of the blood-brain barrier; thus, end-stage renal disease (ESRD) may alter the effects of targeted temperature management (TTM) on the neurological outcomes of out-of-hospital cardiac arrest (OHCA) patients. We aimed to investigate whether the interaction effect of TTM on outcomes after OHCA was observed among patients with and without ESRD.
METHODS
Adult OHCA patients with presumed cardiac etiology who attained sustained return of spontaneous circulation from 2013 to 2017 were included using nationwide OHCA registry. The main exposure variable was TTM. The primary endpoint was survival with good neurological recovery. Multivariable logistic regression analysis was performed after adjustment for potential confounders. To compare the effect of ESRD on TTM, an interaction term (TTM × ESRD) was added to the model.
RESULTS
A total of 21,250 patients were included in the analysis; 2693 (12.7%) patients underwent TTM. ESRD was observed in 128 (4.8%) in the TTM group and 767 (4.1%) in the no-TTM group. The TTM group showed better outcomes than the no-TTM group (32.4% vs. 17.2%, p < 0.01). The adjusted odds ratio of TTM for good neurological recovery in the entire study group was 1.15 (95% CI, 1.03-1.29). In the interaction model, the adjusted odds ratio of TTM for good neurological recovery was 0.47 (95% CI, 0.23-0.98) in the ESRD group vs. 1.54 (95% CI, 1.00-2.39) in the no-ESRD group.
CONCLUSIONS
The interaction effect between ESRD and TTM on neurologic outcome was positive in adult OHCA initial survivors with presumed cardiac etiology.
简介
肾脏功能可能会影响血脑屏障的通透性；因此，终末期肾病（ESRD）可能会改变目标温度管理（TTM）对院外心脏骤停（OHCA）患者神经结局的影响。我们旨在研究 ESRD 患者与非 ESRD 患者之间，是否观察到 TTM 对 OHCA 后结局的交互作用。
方法
使用全国性 OHCA 登记处，纳入 2013 年至 2017 年期间因推定心源性病因导致的成人 OHCA 初始存活并恢复自主循环的患者。主要暴露变量是 TTM。主要终点是生存并具有良好的神经恢复。在调整潜在混杂因素后，进行多变量逻辑回归分析。为了比较 ESRD 对 TTM 的影响，在模型中添加了交互项（TTM×ESRD）。
结果
共纳入 21250 例患者进行分析；2693 例（12.7%）患者接受了 TTM。TTM 组中 ESRD 发生率为 12.8%（128 例），非 TTM 组为 4.1%（767 例）。TTM 组的结局优于非 TTM 组（32.4% vs. 17.2%，p<0.01）。整个研究组中 TTM 对良好神经恢复的调整后比值比为 1.15（95%CI，1.03-1.29）。在交互模型中，ESRD 组 TTM 对良好神经恢复的调整后比值比为 0.47（95%CI，0.23-0.98），而非 ESRD 组为 1.54（95%CI，1.00-2.39）。
结论
在具有推定心源性病因的成人 OHCA 初始存活者中，ESRD 与 TTM 对神经结局的交互作用为正。
Zotero 插件