Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, School of Pharmacy, University of Pittsburgh, 5607 Baum Boulevard, Pittsburgh, PA, 15206, USA.
Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, 15206, USA.
Sci Rep. 2021 Sep 30;11(1):19409. doi: 10.1038/s41598-021-98734-x.
The purpose of this study is to identify medications with potentially beneficial effects on decreasing mortality in patients with acute kidney injury (AKI) while in the intensive care unit (ICU). We used logistic regression to investigate associations between medications received and ICU mortality in patients with AKI in the MIMIC III database. Drugs associated with reduced mortality were then validated using the eICU database. Propensity score matching (PSM) was used for matching the patients' baseline severity of illness followed by a chi-square test to calculate the significance of drug use and mortality. Finally, we examined gene expression signatures to explore the drug's molecular mechanism on AKI. While several drugs demonstrated potential beneficial effects on reducing mortality, most were used for potentially fatal illnesses (e.g. antibiotics, cardiac medications). One exception was found, ondansetron, a drug without previously identified life-saving effects, has correlation with lower mortality among AKI patients. This association was confirmed in a subsequent analysis using the eICU database. Based on the comparison of gene expression signatures, the presumed therapeutic effect of ondansetron may be elicited through the NF-KB pathway and JAK-STAT pathway. Our findings provide real-world evidence to support clinical trials of ondansetron for treatment of AKI.
本研究旨在确定在重症监护病房(ICU)中具有潜在有益效果降低急性肾损伤(AKI)患者死亡率的药物。我们使用逻辑回归方法研究了 MIMIC III 数据库中 AKI 患者接受的药物与 ICU 死亡率之间的关系。然后使用 eICU 数据库验证与降低死亡率相关的药物。使用倾向评分匹配(PSM)来匹配患者的基线疾病严重程度,然后进行卡方检验以计算药物使用和死亡率的显著性。最后,我们检查了基因表达谱,以探讨药物对 AKI 的分子机制。虽然有几种药物显示出降低死亡率的潜在有益效果,但大多数药物用于潜在致命疾病(例如抗生素、心脏药物)。有一个例外,昂丹司琼,一种以前没有确定有救生作用的药物,与 AKI 患者的死亡率降低有关。这一关联在随后使用 eICU 数据库进行的分析中得到了证实。基于基因表达谱的比较,昂丹司琼的假定治疗效果可能是通过 NF-KB 途径和 JAK-STAT 途径引起的。我们的研究结果为开展昂丹司琼治疗 AKI 的临床试验提供了真实世界的证据。