早期昂丹司琼给药与危重症患者院内死亡率的关联：对 MIMIC-IV 数据库的分析。
Association between early ondansetron administration and in-hospital mortality in critically ill patients: analysis of the MIMIC-IV database.
机构信息
Department of Phase I Clinical Trial Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
Department of Anaesthesiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
出版信息
J Transl Med. 2022 May 14;20(1):223. doi: 10.1186/s12967-022-03401-y.
BACKGROUND
While ondansetron (OND) is widespread availability, the contribution of OND to improve patient outcomes among intensive care unit (ICU) patients has not been examined. This study aimed to illustrate the association between early OND use and in-hospital mortality in critically ill patients and investigate whether this association differed according to OND dose.
METHODS
The MIMIC-IV database was employed to identify patients who had and had not received OND. Statistical approaches included multivariate logistic regression, propensity score matching (PSM), and propensity score-based inverse probability of treatment weighting (IPTW) models to ensure the robustness of our findings.
RESULTS
In total, 51,342 ICU patients were included. A significant benefit in terms of in-hospital mortality was observed in the OND patients compared to the non-OND group in the early stage [odds ratio (OR) = 0.75, 95% CI 0.63-0.89, p < 0.001]. In the circulatory system group, the early OND administration was associated with improved in-hospital mortality in ICU patients (OR 0.48, 95% CI 0.34-0.66; P < 0.001). The risk of in-hospital mortality was also lower in early OND users than in non-OND users both in the medical admission group and the surgical ICU admission group, and ORs were 0.57 (95% CI 0.42-0.76; P < 0.001) and 0.79 (95% CI 0.62-0.91; P < 0.001), respectively. A positive role of daily low- and moderate-dose OND treatment in early-stage was showed on the in-hospital mortality in PSM cohort, and the ORs were 0.75 (95% CI 0.62-0.90; P < 0.001) and 0.63 (95% CI 0.43-0.91; P < 0.001), respectively. The relationship between the daily low- and moderate-dose of OND and in-hospital mortality was also significant in ICU patients with cardiovascular diseases, and ORs were 0.51(95% CI 0.36-0.73; P < 0.001), and 0.26(95% CI 0.11-0.65; P < 0.001), respectively. Daily low-to-moderate dose of OND was also associated with in-hospital mortality in ICU entire cohort.
CONCLUSIONS
Early OND use is closely associated with lower in-hospital mortality in ICU patients. Daily low-to-moderate dose of OND application is protective against in-hospital mortality. This association is more evident in the circulatory system group.
背景
尽管昂丹司琼（OND）广泛可用，但OND 对改善重症监护病房（ICU）患者预后的作用尚未得到检验。本研究旨在阐明 ICU 危重症患者早期使用 OND 与院内死亡率之间的关联，并探讨这种关联是否因 OND 剂量而异。
方法
本研究使用 MIMIC-IV 数据库来确定使用和未使用 OND 的患者。统计方法包括多变量逻辑回归、倾向评分匹配（PSM）和倾向评分逆概率治疗加权（IPTW）模型，以确保研究结果的稳健性。
结果
共纳入 51342 名 ICU 患者。与非 OND 组相比，早期 OND 治疗组的院内死亡率显著降低[比值比（OR）=0.75，95%置信区间 0.63-0.89，p<0.001]。在循环系统组中，早期 OND 治疗与 ICU 患者的院内死亡率降低相关（OR 0.48，95%置信区间 0.34-0.66；p<0.001）。与非 OND 使用者相比，早期 OND 使用者在医疗入院组和外科 ICU 入院组的院内死亡率也较低，OR 分别为 0.57（95%置信区间 0.42-0.76；p<0.001）和 0.79（95%置信区间 0.62-0.91；p<0.001）。PSM 队列中，早期低剂量和中剂量 OND 治疗对院内死亡率具有积极作用，OR 分别为 0.75（95%置信区间 0.62-0.90；p<0.001）和 0.63（95%置信区间 0.43-0.91；p<0.001）。在心血管疾病 ICU 患者中，低剂量和中剂量 OND 与院内死亡率之间的关系也具有统计学意义，OR 分别为 0.51（95%置信区间 0.36-0.73；p<0.001）和 0.26（95%置信区间 0.11-0.65；p<0.001）。在 ICU 整个队列中，低至中剂量的 OND 也与院内死亡率相关。
结论
早期 OND 使用与 ICU 患者的院内死亡率降低密切相关。每日低至中剂量的 OND 应用可预防院内死亡率。这种关联在循环系统组中更为明显。
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