Mao Hui, Yu Yi, Wang Qianqian, Li Hengjie
Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
Department of Critical Care Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Front Med (Lausanne). 2023 Dec 21;10:1328636. doi: 10.3389/fmed.2023.1328636. eCollection 2023.
Acute respiratory distress syndrome (ARDS) is a severe condition associated with high morbidity, mortality, and healthcare costs. Despite extensive research, treatment options for ARDS are suboptimal.
This study encompassed patients diagnosed with ARDS from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Pre-intensive care unit (ICU) statin use was assessed as the exposure variable. Kaplan-Meier survival analysis was conducted to evaluate mortality at 30 and 90 days. Adjusted multivariable Cox models were utilized to estimate hazard ratios. Subgroup analyses and propensity score-matching (PSM) were undertaken for further validation.
Our study comprised 10,042 participants diagnosed with ARDS, with an average age of 61.8 ± 15.3 years. Kaplan-Meier survival analysis demonstrated a significantly lower prevalence of mortality at 30 and 90 days in individuals who used statins before ICU admission. Adjusted multivariable Cox models consistently showed a significant decrease in mortality prevalence associated with pre-ICU statin use. After accounting for confounding factors, patients who used statins before ICU admission experienced a 39% reduction in 30-day mortality and 38% reduction in 90-day mortality. We found a significant decrease in ICU stay (0.84 days) for those who used statins before ICU admission. These results were supported by subgroup analyses and PSM.
This large cohort study provides evidence supporting the association between pre-ICU statin use, reduced risk of death, and shorter ICU stay in patients with ARDS, thereby suggesting the potential benefits of statin use in critically ill patients.
急性呼吸窘迫综合征（ARDS）是一种严重疾病，具有高发病率、高死亡率和高昂的医疗成本。尽管进行了广泛研究，但ARDS的治疗选择仍不尽人意。
本研究纳入了从重症监护医学信息数据库-IV（MIMIC-IV）中诊断为ARDS的患者。将重症监护病房（ICU）入院前他汀类药物的使用作为暴露变量进行评估。采用Kaplan-Meier生存分析评估30天和90天的死亡率。使用调整后的多变量Cox模型估计风险比。进行亚组分析和倾向评分匹配（PSM）以进一步验证。
我们的研究包括10042名诊断为ARDS的参与者，平均年龄为61.8±15.3岁。Kaplan-Meier生存分析表明，在ICU入院前使用他汀类药物的个体中，30天和90天的死亡率显著降低。调整后的多变量Cox模型一致显示，与ICU入院前使用他汀类药物相关的死亡率显著降低。在考虑混杂因素后，ICU入院前使用他汀类药物的患者30天死亡率降低39%，90天死亡率降低38%。我们发现，ICU入院前使用他汀类药物的患者的ICU住院时间显著缩短（0.84天）。这些结果得到了亚组分析和PSM的支持。
这项大型队列研究提供了证据，支持ICU入院前使用他汀类药物与ARDS患者死亡风险降低和ICU住院时间缩短之间的关联，从而表明他汀类药物在危重症患者中使用的潜在益处。
