Dorn Research Institute, Columbia VA Health Care System, Columbia, South Carolina, USA.
Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA.
J Pineal Res. 2022 Sep;73(2):e12811. doi: 10.1111/jpi.12811. Epub 2022 Jun 9.
Prior research suggests melatonin has beneficial effects that could improve survival among sepsis patients. This exploratory analysis sought to compare 30-day survival among melatonin treated and untreated patients with sepsis. A retrospective cohort study was conducted among patients with a primary inpatient admission diagnosis for sepsis utilizing the International Classification of Diseases, versions 9 and 10, Clinical Modification (ICD-9-CM and ICD-10-CM) diagnosis codes between 2000 and 2021. Propensity score weighting was utilized, accounting for demographic, clinical, and laboratory factors. Weighted Cox models were estimated for 30-day in-hospital and 30-day overall survival. A total of 9386 patients were included in the study with 593 exposed to melatonin within the first day of hospitalization. Propensity score weighted Cox models reveal melatonin was associated with a 37.9% decreased risk of 30-day in-hospital mortality (HR = 0.621; 95% CI = [0.415-0.931]) and a 33.5% decreased risk of 30-day overall mortality (HR = 0.665; 95% CI = [0.493-0.897]). Factors associated with higher risk of both in-hospital and overall mortality include male sex, white race, age, higher Charlson comorbidity burden, sodium and potassium levels, intensive care unit stay, invasive ventilation, and vasopressor use. Higher serum albumin levels are associated with lower mortality risks. Among patients diagnosed with sepsis, exposure to melatonin was associated with a lower in-hospital and 30-day mortality. Additional research is warranted to fully understand the role of melatonin in sepsis.
先前的研究表明，褪黑素具有有益的作用，可以提高脓毒症患者的生存率。本探索性分析旨在比较接受和未接受褪黑素治疗的脓毒症患者的 30 天生存率。利用国际疾病分类第 9 版和第 10 版临床修订版（ICD-9-CM 和 ICD-10-CM）诊断代码，对 2000 年至 2021 年间因脓毒症首次住院的患者进行了回顾性队列研究。利用倾向评分加权法，考虑了人口统计学、临床和实验室因素。对住院 30 天和总 30 天生存率进行了加权 Cox 模型估计。共有 9386 例患者纳入研究，其中 593 例在住院第一天接受了褪黑素治疗。倾向评分加权 Cox 模型显示，褪黑素与住院 30 天内死亡率降低 37.9%相关（HR=0.621；95%CI=[0.415-0.931]），与 30 天总死亡率降低 33.5%相关（HR=0.665；95%CI=[0.493-0.897]）。与住院和总死亡率较高相关的因素包括男性、白种人、年龄、较高的 Charlson 合并症负担、钠和钾水平、重症监护病房入住、有创通气和血管加压素使用。较高的血清白蛋白水平与较低的死亡率风险相关。在诊断为脓毒症的患者中，暴露于褪黑素与住院和 30 天死亡率降低相关。需要进一步研究以充分了解褪黑素在脓毒症中的作用。
