Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
BMJ Open. 2023 Feb 22;13(2):e066117. doi: 10.1136/bmjopen-2022-066117.
Application of hyperbaric oxygen (HBO) treatment in the multidisciplinary setting of necrotising soft-tissue infection (NSTI) is debated as a considerable number of studies are of low quality with marked prognostication bias due to inadequately addressing disease severity. The objective of this study was to associate HBO treatment with mortality in patients with NSTI including disease severity as a prognostic variable.
Nationwide population-based register study.
Denmark.
Danish residents with NSTI patients between January 2011 and June 2016.
Thirty-day mortality was compared between patients receiving and patients not receiving HBO treatment using inverse probability of treatment weighting and propensity-score matching with predetermined variables (age, sex and weighted Charlson comorbidity score, presence of septic shock and Simplified Acute Physiology Score II (SAPS II)).
A total of 671 NSTI patients were included with a median age of 63 (52-71), 61% male sex, 30% had septic shock and a median SAPS II of 46 (34-58). Patients who received HBO treatment (n=266) were younger and had lower SAPS II, but a larger fraction had septic shock compared with patients not receiving HBO treatment. Overall, all-cause 30-day mortality was 19% (95% CI 17% to 23%). The statistical models were in general acceptably balanced with covariates reaching <0.1 absolute standardised mean differences and patients receiving HBO treatment were associated with lower 30-day mortality (OR 0.40, 95% CI 0.30 to 0.53, p<0.001).
In analyses using inverse probability of treatment weighting and propensity score analysis, patients treated with HBO treatment were associated with improved 30-day survival.
高压氧（HBO）治疗在坏死性软组织感染（NSTI）的多学科治疗中的应用存在争议，因为大量研究质量较低，由于未能充分考虑疾病严重程度，存在明显的预后偏倚。本研究的目的是将 HBO 治疗与 NSTI 患者的死亡率相关联，包括将疾病严重程度作为预后变量。
全国基于人群的登记研究。
丹麦。
2011 年 1 月至 2016 年 6 月期间患有 NSTI 的丹麦居民。
使用逆概率治疗加权和倾向评分匹配（使用预先确定的变量：年龄、性别和加权 Charlson 合并症评分、是否存在感染性休克和简化急性生理学评分 II（SAPS II））比较接受和未接受 HBO 治疗的患者的 30 天死亡率。
共纳入 671 例 NSTI 患者，中位年龄为 63 岁（52-71 岁），61%为男性，30%存在感染性休克，SAPS II 中位数为 46（34-58）。接受 HBO 治疗的患者（n=266）年龄较小，SAPS II 较低，但与未接受 HBO 治疗的患者相比，有更大比例的患者发生感染性休克。总体而言，所有原因的 30 天死亡率为 19%（95%CI 17%-23%）。在一般情况下，统计模型具有可接受的平衡，协变量达到<0.1 的绝对标准化均数差，接受 HBO 治疗的患者 30 天死亡率较低（OR 0.40，95%CI 0.30-0.53，p<0.001）。
在使用逆概率治疗加权和倾向评分分析的分析中，接受 HBO 治疗的患者与提高 30 天生存率相关。
