急性呼吸窘迫综合征患者的血液嗜酸性粒细胞与死亡率：一项倾向评分匹配分析
Blood eosinophils and mortality in patients with acute respiratory distress syndrome: A propensity score matching analysis.
作者信息
Chen Hao-Tian, Xu Jian-Feng, Huang Xiao-Xia, Zhou Ni-Ya, Wang Yong-Kui, Mao Yue
机构信息
Department of Emergency Intensive Care Unit, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.
Department of Respiratory Therapy, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.
出版信息
World J Emerg Med. 2021;12(2):131-136. doi: 10.5847/wjem.j.1920-8642.2021.02.008.
BACKGROUND
The effect of blood eosinophils (EOSs) on mortality in acute respiratory distress syndrome (ARDS) patients and whether corticosteroids affect this effect are unclear.
METHODS
The Medical Information Mart for Intensive Care III database (version 1.4) was used to extract data. Patients with ARDS were selected for inclusion. Cox regression models using the backward stepwise method and propensity score matching (PSM) were used to assess the relationship between blood EOS counts and 28-day mortality.
RESULTS
A total of 2,567 patients with ARDS were included, and the 28-day mortality rate was 24.19%. The crude 28-day mortality was significantly lower in patients with EOS counts ≥2% (18.60% [85/457] vs. 25.40% [536/2,110], =0.002) than in those with EOS counts <2%. In the Cox regression model, the EOS counts ≥2% showed a significant association with the decreased 28-day mortality (hazard ratio [] 0.731; 95% confidence interval [95% ] 0.581-0.921, =0.008). In the corticosteroid non-use subgroup, EOS counts ≥2% was significantly related to decreased 28-day mortality ( 0.697, 95% 0.535-0.909, =0.008), but the result was not significant in the corticosteroid non-use subgroup model (=0.860). A total of 457 well-matched pairs were obtained by a 1:1 matching algorithm after PSM. The 28-day mortality remained significantly lower in the EOS counts ≥2% group (18.60% [85/457] vs. 26.70% [122/457], =0.003).
CONCLUSIONS
Higher EOS counts are related to lower 28-day mortality in ARDS patients, and this relationship can be counteracted by using corticosteroids.
背景
血液嗜酸性粒细胞（EOS）对急性呼吸窘迫综合征（ARDS）患者死亡率的影响以及皮质类固醇是否会影响这种作用尚不清楚。
方法
使用重症监护医学信息集市III数据库（1.4版）提取数据。选取ARDS患者纳入研究。采用向后逐步法的Cox回归模型和倾向评分匹配（PSM）来评估血液EOS计数与28天死亡率之间的关系。
结果
共纳入2567例ARDS患者，28天死亡率为24.19%。EOS计数≥2%的患者28天粗死亡率（18.60%[85/457] vs. 25.40%[536/2110]，P = 0.002）显著低于EOS计数<2%的患者。在Cox回归模型中，EOS计数≥2%与28天死亡率降低显著相关（风险比[HR] 0.731；95%置信区间[95%CI] 0.581 - 0.921，P = 0.008）。在未使用皮质类固醇的亚组中，EOS计数≥2%与28天死亡率降低显著相关（P = 0.697，95%CI 0.535 - 0.909，P = 0.008），但在使用皮质类固醇的亚组模型中结果不显著（P = 0.860）。PSM后通过1:1匹配算法共获得457对匹配良好的配对。EOS计数≥2%组的28天死亡率仍显著较低（18.60%[85/457] vs. 26.70%[122/457]，P = 0.003）。
结论
较高的EOS计数与ARDS患者较低的28天死亡率相关，而使用皮质类固醇可抵消这种关系。
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