帕罗西汀与心力衰竭死亡率：一项回顾性队列研究

Paroxetine and Mortality in Heart Failure: A Retrospective Cohort Study.

作者信息

Xu Hongxuan, Meng Lingbing, Long Huanyu, Shi Yueping, Liu Yunqing, Wang Li, Liu Deping

机构信息

Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.

The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.

出版信息

Front Cardiovasc Med. 2022 Jan 26;8:794584. doi: 10.3389/fcvm.2021.794584. eCollection 2021.

DOI:10.3389/fcvm.2021.794584

PMID:35155607

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8825765/

Abstract

INTRODUCTION

Paroxetine is a GRK2 inhibitor that has been widely used to treat depression and anxiety over the last few decades. The inhibition of GRK2 has been studied extensively ; however, evidence of its impact on heart failure remains scarce.

METHODS

To assess the association between paroxetine use and mortality in patients with heart failure. We conducted a retrospective longitudinal cohort study from 2008 to 2019, with a follow-up time of 28 days for all groups. This is a single-center study using the Medical Information Mart for Intensive Care IV database with 11,657 heart failure patients identified. We performed genetic matching to adjust for the covariates. Heart failure patients prescribed paroxetine for >24 h after hospital admission were categorized into the paroxetine group (77 patients), with remaining heart failure patients making up the matched control group (231 patients). The primary outcome was 28-day all-cause mortality from the date of hospital admission. Secondary outcomes included length of intensive care unit stay, length of hospital stay, and in-hospital mortality. The Kaplan-Meier survival estimator, logistic regression, Cox regression, and restricted mean survival time were used to detect the association between paroxetine therapy and outcomes.

RESULTS

Patients who received paroxetine during one hospital admission lived, on average, 0.7 lesser days (95% CI -2.53 to 1.1, = 0.46) than patients who did not use it in a 28-day truncation time point. Multivariable logistic regression, including all matched covariates, demonstrated that the adjusted odds ratio of 28-day mortality of the paroxetine administration group was 1.1 (95% CI 0.37-2.9, = 0.90). Multivariable Cox regression of 28-day mortality presented an adjusted hazard ratio of 1.00 (95% CI 0.42-2.62, = 0.92). Paroxetine was associated with an increased survival time at a 3,000-day truncation time point (203 days, 95% CI -305.69 to 817.8, = 0.37).

CONCLUSIONS

In patients with heart failure, treatment with paroxetine did not significantly reduce 28-day all-cause mortality.

摘要

引言

帕罗西汀是一种GRK2抑制剂，在过去几十年中已被广泛用于治疗抑郁症和焦虑症。GRK2的抑制作用已得到广泛研究；然而，其对心力衰竭影响的证据仍然很少。

方法

为了评估帕罗西汀的使用与心力衰竭患者死亡率之间的关联。我们进行了一项回顾性纵向队列研究，时间跨度为2008年至2019年，所有组的随访时间为28天。这是一项单中心研究，使用重症监护医学信息集市IV数据库，共识别出11657例心力衰竭患者。我们进行了基因匹配以调整协变量。入院后接受帕罗西汀治疗超过24小时的心力衰竭患者被归入帕罗西汀组（77例患者），其余心力衰竭患者组成匹配对照组（231例患者）。主要结局是从入院日期起的28天全因死亡率。次要结局包括重症监护病房住院时间、住院时间和院内死亡率。采用Kaplan-Meier生存估计器、逻辑回归、Cox回归和受限平均生存时间来检测帕罗西汀治疗与结局之间的关联。

结果

在28天的截断时间点，在一次住院期间接受帕罗西汀治疗的患者平均存活天数比未使用帕罗西汀的患者少0.7天（95%置信区间为-2.53至1.1，P = 0.46）。包括所有匹配协变量的多变量逻辑回归表明，帕罗西汀给药组28天死亡率的调整优势比为1.1（95%置信区间为0.37-2.9，P = 0.90）。28天死亡率的多变量Cox回归显示调整后的风险比为1.00（95%置信区间为0.42-2.62，P = 0.92）。在3000天的截断时间点，帕罗西汀与生存时间延长相关（203天，95%置信区间为-305.69至817.8，P = 0.37）。