基于 MIMIC-IV 数据库的回顾性研究：早期血管加压素联合去甲肾上腺素对脓毒性休克短期死亡率的影响。
Effect of early vasopressin combined with norepinephrine on short-term mortality in septic shock: A retrospective study based on the MIMIC-IV database.
机构信息
Department of Anesthesiology, Hengyang Maternal and Child Health Hospital, Hengyang, China; 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.
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.
出版信息
Am J Emerg Med. 2023 Jul;69:188-194. doi: 10.1016/j.ajem.2023.04.040. Epub 2023 May 3.
BACKGROUND
Septic shock is a leading cause of death in intensive care units (ICUs), with short-term mortality rates of 35-40%. Vasopressin (AVP) is a second-line vasoactive agent for septic shock, and recent studies suggest that early AVP use can be beneficial. However, differences between early initiation of AVP combined with norepinephrine (NE) and nonearly AVP with NE are unclear. A retrospective cohort research was designed to explore the effects of early AVP initiation versus nonearly AVP initiation.
METHODS
This retrospective single-center cohort study included adult patients with septic shock from the MIMIC (Medical Information Mart for Intensive Care)-IV database. According to whether AVP was used early in the ICU (intensive care unit), patients were assigned to the early- (within 6 h of septic shock onset) and non-early-AVP (at least 6 h after septic shock onset) groups. The primary outcome was 28-day mortality. The secondary outcomes were ICU and hospital mortality, the numbers of vasopressor-free and ventilation-free days at 28 days, ICU length of stay (LOS), hospital LOS, sequential organ failure assessment (SOFA) score on days 2 and 3, and renal replacement therapy (RRT) use on days 2 and 3. Univariate and multivariate cox proportional-hazards regression, propensity-score matching were used to analyze the differences between the groups.
RESULTS
The study included 531 patients with septic shock: 331 (62.5%) in the early-AVP group and 200 (37.5%) in the non-early-AVP group. For 1:1 matching, 158 patients in the early-AVP group were matched with the same number of patients with nonearly AVP. Regarding the primary outcome, there was no significant difference between the early- and non-early-AVP groups in 28-day mortality (hazard ratio [HR] = 0.91, 95% confidence interval [CI] = 0.68-1.24). For the secondary outcomes, there were no differences between the early- and non-early-AVP groups in ICU mortality (HR = 0.95, 95% CI = 0.67-1.35), hospital mortality (HR = 0.95, 95% CI = 0.69-1.31), the numbers of vasopressor-free and ventilation-free days at 28 days, ICU LOS, hospital LOS, SOFA score on days 2 and 3, and RRT use on days 2 and 3.
CONCLUSIONS
There was no difference in short-term mortality between early AVP combined with NE and nonearly AVP with NE in septic shock.
背景
脓毒性休克是重症监护病房（ICU）死亡的主要原因，短期死亡率为 35-40%。加压素（AVP）是脓毒性休克的二线血管活性药物，最近的研究表明早期使用 AVP 可能有益。然而，早期开始使用 AVP 联合去甲肾上腺素（NE）与不早期开始使用 AVP 联合 NE 之间的差异尚不清楚。本回顾性队列研究旨在探讨早期开始 AVP 与不早期开始 AVP 的效果。
方法
本回顾性单中心队列研究纳入了来自 MIMIC-IV（重症监护信息学医学信息市场）数据库的成年脓毒性休克患者。根据 ICU 中是否早期使用 AVP（脓毒性休克发病后 6 小时内），将患者分为早期（AVP）组（脓毒性休克发病后 6 小时内）和非早期（AVP）组（至少在脓毒性休克发病后 6 小时后）。主要结局为 28 天死亡率。次要结局为 ICU 死亡率和医院死亡率、28 天无血管加压药天数和无机械通气天数、ICU 住院时间（LOS）、医院 LOS、第 2 天和第 3 天序贯器官衰竭评估（SOFA）评分、第 2 天和第 3 天肾脏替代治疗（RRT）的使用情况。使用单变量和多变量 Cox 比例风险回归、倾向评分匹配来分析组间差异。
结果
研究纳入了 531 例脓毒性休克患者：早期 AVP 组 331 例（62.5%），非早期 AVP 组 200 例（37.5%）。1:1 匹配后，早期 AVP 组有 158 例与非早期 AVP 组匹配。在主要结局方面，28 天死亡率在早期 AVP 组与非早期 AVP 组之间无显著差异（风险比 [HR] = 0.91，95%置信区间 [CI] = 0.68-1.24）。次要结局方面，两组在 ICU 死亡率（HR = 0.95，95%CI = 0.67-1.35）、医院死亡率（HR = 0.95，95%CI = 0.69-1.31）、28 天无血管加压药天数和无机械通气天数、ICU LOS、医院 LOS、第 2 天和第 3 天 SOFA 评分、第 2 天和第 3 天 RRT 使用情况方面均无差异。
结论
脓毒性休克中，早期 AVP 联合 NE 与非早期 AVP 联合 NE 短期死亡率无差异。
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