Zhang Luming, Li Shaojin, Lu Xuehao, Liu Yu, Ren Yinlong, 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 23;13:898566. doi: 10.3389/fphar.2022.898566. eCollection 2022.
Ventilator-associated pneumonia (VAP) is a common infection complication in intensive care units (ICU). It not only prolongs mechanical ventilation and ICU and hospital stays, but also increases medical costs and increases the mortality risk of patients. Although many studies have found that thiamine supplementation in critically ill patients may improve prognoses, there is still no research or evidence that thiamine supplementation is beneficial for patients with VAP. The purpose of this study was to determine the association between thiamine and the prognoses of patients with VAP. This study retrospectively collected all patients with VAP in the ICU from the Medical Information Mart for Intensive Care-IV database. The outcomes were ICU and in-hospital mortality. Patients were divided into the no-thiamine and thiamine groups depending upon whether or not they had received supplementation. Associations between thiamine and the outcomes were tested using Kaplan-Meier (KM) survival curves and Cox proportional-hazards regression models. The statistical methods of propensity-score matching (PSM) and inverse probability weighting (IPW) based on the XGBoost model were also applied to ensure the robustness of our findings. The study finally included 1,654 patients with VAP, comprising 1,151 and 503 in the no-thiamine and thiamine groups, respectively. The KM survival curves indicated that the survival probability differed significantly between the two groups. After multivariate COX regression adjusted for confounding factors, the hazard ratio (95% confidence interval) values for ICU and in-hospital mortality in the thiamine group were 0.57 (0.37, 0.88) and 0.64 (0.45, 0.92), respectively. Moreover, the results of the PSM and IPW analyses were consistent with the original population. Thiamine supplementation may reduce ICU and in-hospital mortality in patients with VAP in the ICU. Thiamine is an inexpensive and safe drug, and so further clinical trials should be conducted to provide more-solid evidence on whether it improves the prognosis of patients with VAP.
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）常见的感染并发症。它不仅会延长机械通气时间以及ICU住院时间和总住院时间，还会增加医疗费用，并提高患者的死亡风险。尽管许多研究发现，对重症患者补充硫胺素可能改善预后，但仍没有研究或证据表明补充硫胺素对VAP患者有益。本研究的目的是确定硫胺素与VAP患者预后之间的关联。 本研究从重症监护医学信息集市第四版（Medical Information Mart for Intensive Care-IV）数据库中回顾性收集了ICU中所有VAP患者。观察指标为ICU死亡率和住院死亡率。根据患者是否接受过硫胺素补充治疗，将患者分为未补充硫胺素组和补充硫胺素组。使用Kaplan-Meier（KM）生存曲线和Cox比例风险回归模型检验硫胺素与观察指标之间的关联。基于XGBoost模型的倾向评分匹配（PSM）和逆概率加权（IPW）统计方法也被应用，以确保研究结果的稳健性。 该研究最终纳入了1654例VAP患者，未补充硫胺素组和补充硫胺素组分别有1151例和503例。KM生存曲线表明，两组的生存概率存在显著差异。在对混杂因素进行多变量COX回归调整后，补充硫胺素组的ICU死亡率和住院死亡率的风险比（95%置信区间）值分别为0.57（0.37，0.88）和0.64（0.45，0.92）。此外，PSM和IPW分析结果与原始人群一致。 补充硫胺素可能降低ICU中VAP患者的ICU死亡率和住院死亡率。硫胺素是一种廉价且安全的药物，因此应进行进一步的临床试验，以提供更确凿的证据，证明其是否能改善VAP患者的预后。
