Zhang Luming, Li Shaojin, Yuan Shiqi, Lu Xuehao, Li Jieyao, Liu Yu, Huang Tao, Lyu Jun, Yin Haiyan
Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Front Pharmacol. 2022 Jun 8;13:868920. doi: 10.3389/fphar.2022.868920. eCollection 2022.
In intensive care units (ICUs), the morbidity and mortality of ventilator-associated pneumonia (VAP) are relatively high, and this condition also increases medical expenses for mechanically ventilated patients, which will seriously affect the prognoses of critically ill patients. The purpose of this study was to determine the impact of bronchoscopy on the prognosis of patients with VAP undergoing invasive mechanical ventilation (IMV). This was a retrospective study based on patients with VAP from the Medical Information Mart for Intensive Care IV database. The outcomes were ICU and in-hospital mortality. Patients were divided based on whether or not they had undergone bronchoscopy during IMV. Kaplan-Meier (KM) survival curves and Cox proportional-hazards regression models were used to analyze the association between groups and outcomes. Propensity score matching (PSM) and propensity score based inverse probability of treatment weighting (IPTW) were used to further verify the stability of the results. The effect of bronchoscopy on prognosis was further analyzed by causal mediation analysis (CMA). This study enrolled 1,560 patients with VAP: 1,355 in the no-bronchoscopy group and 205 in the bronchoscopy group. The KM survival curve indicated a significant difference in survival probability between the two groups. The survival probabilities in both the ICU and hospital were significantly higher in the bronchoscopy group than in the no bronchoscopy group. After adjusting all covariates as confounding factors in the Cox model, the HRs (95% CI) for ICU and in-hospital mortality in the bronchoscopy group were 0.33 (0.20-0.55) and 0.40 (0.26-0.60), respectively, indicating that the risks of ICU and in-hospital mortality were 0.67 and 0.60 lower than in the no-bronchoscopy group. The same trend was obtained after using PSM and IPTW. CMA showed that delta-red blood cell distribution width (RDW) mediated 8 and 7% of the beneficial effects of bronchoscopy in ICU mortality and in-hospital mortality. Bronchoscopy during IMV was associated with reducing the risk of ICU and in-hospital mortality in patients with VAP in ICUs, and this beneficial effect was partially mediated by changes in RDW levels.
在重症监护病房（ICU）中，呼吸机相关性肺炎（VAP）的发病率和死亡率相对较高，这种情况还会增加机械通气患者的医疗费用，严重影响重症患者的预后。本研究的目的是确定支气管镜检查对接受有创机械通气（IMV）的VAP患者预后的影响。这是一项基于重症监护医学信息集市IV数据库中VAP患者的回顾性研究。结局指标为ICU死亡率和住院死亡率。根据患者在IMV期间是否接受支气管镜检查进行分组。采用Kaplan-Meier（KM）生存曲线和Cox比例风险回归模型分析组间与结局之间的关联。使用倾向评分匹配（PSM）和基于倾向评分的逆概率处理加权（IPTW）进一步验证结果的稳定性。通过因果中介分析（CMA）进一步分析支气管镜检查对预后的影响。本研究纳入了1560例VAP患者：非支气管镜检查组1355例，支气管镜检查组205例。KM生存曲线显示两组的生存概率存在显著差异。支气管镜检查组的ICU生存率和住院生存率均显著高于非支气管镜检查组。在Cox模型中将所有协变量作为混杂因素进行调整后，支气管镜检查组的ICU死亡率和住院死亡率的HR（95%CI）分别为0.33（0.20 - 0.55）和0.40（0.26 - 0.60），表明ICU死亡率和住院死亡率的风险分别比非支气管镜检查组低0.67和0.60。使用PSM和IPTW后得到相同趋势。CMA显示，红细胞分布宽度（RDW）变化介导了支气管镜检查对ICU死亡率和住院死亡率有益作用的8%和7%。IMV期间进行支气管镜检查与降低ICU中VAP患者的ICU死亡率和住院死亡率风险相关，且这种有益作用部分由RDW水平的变化介导。
