Service de Physiologie - Explorations Fonctionnelles, Assistance Publique - Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, 46, rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France.
Université de Paris, Paris, France; Department of Anaesthesiology and Critical Care, Department of Anaesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, Paris, France; Inserm UMR-S 942 MASCOT, Lariboisière Hospital - Paris, France.
Anaesth Crit Care Pain Med. 2022 Feb;41(1):101012. doi: 10.1016/j.accpm.2021.101012. Epub 2021 Dec 21.
Limited information is currently available on the impact of vasoactive medications in intensive care (ICU) and long-term outcomes. The main objective of our study was to describe the association between the use of inotropes and/or vasopressors and ICU mortality. Secondary objectives were to evaluate the association between the use of vasoactive drugs and in-hospital as well as 1-year all-cause mortality in ICU survivors.
FROG-ICU was a prospective, observational, multi-centre cohort designed to investigate long-term mortality of critically ill adult patients. Cox proportional hazards models were used to evaluate the association between the use of inotropes and/or vasopressors and ICU mortality, as well as in-hospital and 1-year all-cause mortality in a propensity-score matched cohort.
The study included 2087 patients, 939 of whom received inotropes and/or vasopressors during the initial ICU stay. Patients treated with vasoactive medications were older and had a more severe clinical presentation. In a propensity score-matched cohort of 1201 patients, ICU mortality was higher in patients who received vasoactive medications (HR of 1.40 [1.10-1.78], p = 0.007). One thousand six hundred thirty-five patients survived the index ICU hospitalisation. There was no significant difference according to the use of inotropes and/or vasopressors in the propensity-score matched cohort on in-hospital mortality (HR of 0.94 [0.60-1.49], p = 0.808) as well as one-year all-cause mortality (HR 0.94 [0.71-1.24], p = 0.643).
Inotropic and/or vasopressor therapy is a strong predictor of in-ICU death. However, the use of inotropes and/or vasopressors during ICU admission was not associated with a worse prognosis after ICU discharge.
目前关于血管活性药物在重症监护病房（ICU）中的应用及其对长期预后的影响的信息有限。本研究的主要目的是描述使用正性肌力药和/或血管加压药与 ICU 死亡率之间的关系。次要目标是评估 ICU 幸存者中血管活性药物的使用与院内和 1 年全因死亡率之间的关系。
FROG-ICU 是一项前瞻性、观察性、多中心队列研究，旨在调查危重症成年患者的长期死亡率。使用 Cox 比例风险模型评估在初始 ICU 住院期间使用正性肌力药和/或血管加压药与 ICU 死亡率之间的关系，以及在倾向评分匹配队列中与院内和 1 年全因死亡率之间的关系。
该研究纳入了 2087 例患者，其中 939 例在初始 ICU 住院期间接受了正性肌力药和/或血管加压药治疗。接受血管活性药物治疗的患者年龄较大，临床表现更严重。在 1201 例接受倾向评分匹配的患者中，接受血管活性药物治疗的患者 ICU 死亡率更高（风险比 1.40 [1.10-1.78]，p=0.007）。1635 例患者在 ICU 住院期间存活。在倾向评分匹配的队列中，使用正性肌力药和/或血管加压药的患者在院内死亡率（风险比 0.94 [0.60-1.49]，p=0.808）和 1 年全因死亡率（风险比 0.94 [0.71-1.24]，p=0.643）方面无显著差异。
正性肌力和/或血管加压治疗是 ICU 内死亡的强预测因素。然而，在 ICU 入住期间使用正性肌力药和/或血管加压药与 ICU 出院后预后不良无关。
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