长期免疫抑制治疗与 ICU 收治的感染性休克患者的不良结局无关：PACIFIC 研究。

Long-term immunosuppressive treatment is not associated with worse outcome in patients hospitalized in the intensive care unit for septic shock: the PACIFIC study.

机构信息

Réanimation Polyvalente, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France.

Service de Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.

出版信息

Crit Care. 2023 Sep 2;27(1):340. doi: 10.1186/s13054-023-04626-z.

DOI:10.1186/s13054-023-04626-z

PMID:37660107

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10475175/

Abstract

BACKGROUND

Except in a few retrospective studies mainly including patients under chemotherapy, information regarding the impact of immunosuppressive therapy on the prognosis of patients admitted to the intensive care unit (ICU) for septic shock is scarce. Accordingly, the PACIFIC study aimed to asses if immunosuppressive therapy is associated with an increased mortality in patients admitted to the ICU for septic shock.

METHODS

This was a retrospective epidemiological multicentre study. Eight high enroller centres in septic shock randomised controlled trials (RCTs) participated in the study. Patients in the "exposed" group were selected from the screen failure logs of seven recent RCTs and excluded because of immunosuppressive treatment. The "non-exposed" patients were those included in the placebo arm of the same RCTs. A multivariate logistic regression model was used to estimate the risk of death.

RESULTS

Among the 433 patients enrolled, 103 were included in the "exposed" group and 330 in the "non-exposed" group. Reason for immunosuppressive therapy included organ transplantation (n = 45 [44%]) or systemic disease (n = 58 [56%]). ICU mortality rate was 24% in the "exposed" group and 25% in the "non-exposed" group (p = 0.9). Neither in univariate nor in multivariate analysis immunosuppressive therapy was associated with a higher ICU mortality (OR: 0.95; [95% CI 0.56-1.58]: p = 0.86 and 1.13 [95% CI 0.61-2.05]: p = 0.69, respectively) or 3-month mortality (OR: 1.13; [95% CI 0.69-1.82]: p = 0.62 and OR: 1.36 [95% CI 0.78-2.37]: p = 0.28, respectively).

CONCLUSIONS

In this study, long-term immunosuppressive therapy excluding chemotherapy was not associated with significantly higher or lower ICU and 3-month mortality in patients admitted to the ICU for septic shock.

摘要

背景

除了少数主要包括接受化疗的患者的回顾性研究外，关于免疫抑制治疗对因感染性休克入住重症监护病房（ICU）的患者预后的影响的信息很少。因此，PACIFIC 研究旨在评估免疫抑制治疗是否与因感染性休克入住 ICU 的患者死亡率增加有关。

方法

这是一项回顾性的、多中心的流行病学研究。七项最近的感染性休克随机对照试验（RCT）中，有 8 个高入组中心参与了这项研究。“暴露”组的患者从七项 RCT 的筛选失败日志中筛选出来，因接受免疫抑制治疗而被排除。“非暴露”患者为同一 RCT 安慰剂组的纳入患者。使用多变量逻辑回归模型来估计死亡风险。

结果

在纳入的 433 名患者中，有 103 名患者纳入“暴露”组，330 名患者纳入“非暴露”组。免疫抑制治疗的原因包括器官移植（n=45[44%]）或全身疾病（n=58[56%]）。“暴露”组的 ICU 死亡率为 24%，“非暴露”组为 25%（p=0.9）。无论是在单变量分析还是多变量分析中，免疫抑制治疗与更高的 ICU 死亡率（OR：0.95[95%CI 0.56-1.58]：p=0.86 和 1.13[95%CI 0.61-2.05]：p=0.69）或 3 个月死亡率（OR：1.13[95%CI 0.69-1.82]：p=0.62 和 OR：1.36[95%CI 0.78-2.37]：p=0.28）无关。