Zhu Jia-Liang, Hong Liang, Yuan Shi-Qi, Xu Xiao-Mei, Wei Jian-Rui, Yin Hai-Yan
Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.
Front Pharmacol. 2023 Jan 12;14:1118551. doi: 10.3389/fphar.2023.1118551. eCollection 2023.
Heart failure (HF) is the terminal stage of various heart diseases. Conventional treatments have poor efficacy, and diuretic resistance can present. Previous studies have found that the use of glucocorticoids can enhance the diuretic effect of patients with heart failure and reduce heart failure symptoms. However, the relationship between glucocorticoid use and mortality in patients with heart failure in intensive care units is unclear. The aim of this study was to determine the association between glucocorticoid use and all-cause mortality in critically ill patients with heart failure. Methods: The information on patients with heart failure in this study was extracted from the MIMIC-III (Medical Information Mart for Intensive Care-III) database. Patients in the glucocorticoid and non-glucocorticoid groups were matched using propensity scores. The Kaplan-Meier method was used to explore the difference in survival probability between the two groups. A Cox proportional-hazards regression model was used to analyze the hazard ratios (HRs) for the two patient groups. Subgroup analyses were performed with prespecified stratification variables to demonstrate the robustness of the results. The study included 9,482 patients: 2,099 in the glucocorticoid group and 7,383 in the non-glucocorticoid group. There were 2,055 patients in each group after propensity-score matching. The results indicated that the non-glucocorticoid group was not significantly associated with reduced mortality in patients with heart failure during the 14-day follow-up period [HRs = .901, 95% confidence interval (CI) = .767-1.059]. During the follow-up periods of 15-30 and 15-90 days, the mortality risk was significantly lower in the non-glucocorticoid group than in the glucocorticoid group (HRs = .497 and 95% CI = .370-.668, and HRs = .400 and 95% CI = .310-.517, respectively). Subgroup analyses indicated no interaction among each stratification variable and glucocorticoid use. Glucocorticoid use was associated with an increased mortality risk in critically ill patients with heart failure.
心力衰竭（HF）是各种心脏病的终末期。传统治疗效果不佳，且可能出现利尿剂抵抗。先前的研究发现，使用糖皮质激素可增强心力衰竭患者的利尿作用并减轻心力衰竭症状。然而，重症监护病房中心力衰竭患者使用糖皮质激素与死亡率之间的关系尚不清楚。本研究的目的是确定重症心力衰竭患者使用糖皮质激素与全因死亡率之间的关联。方法：本研究中心力衰竭患者的信息取自MIMIC-III（重症监护医学信息数据库-III）数据库。使用倾向评分对糖皮质激素组和非糖皮质激素组的患者进行匹配。采用Kaplan-Meier方法探索两组之间生存概率的差异。使用Cox比例风险回归模型分析两组患者的风险比（HRs）。使用预先设定的分层变量进行亚组分析，以证明结果的稳健性。该研究纳入了9482例患者：糖皮质激素组2099例，非糖皮质激素组7383例。倾向评分匹配后，每组有2055例患者。结果表明，在14天的随访期内，非糖皮质激素组与心力衰竭患者死亡率降低无显著关联[HRs = 0.901，95%置信区间（CI）= 0.767 - 1.059]。在15 - 30天和15 - 90天的随访期内，非糖皮质激素组的死亡风险显著低于糖皮质激素组（HRs分别为0.497，95% CI = 0.370 - 0.668；HRs为0.400，95% CI = 0.310 - 0.517）。亚组分析表明，各分层变量与糖皮质激素使用之间无相互作用。心力衰竭重症患者使用糖皮质激素与死亡风险增加相关。
