新型冠状病毒肺炎患者血管加压药使用数量与死亡率之间的关联
Association between number of vasopressors and mortality in COVID-19 patients.
作者信息
Sunnaa Michael, Kerolos Mina, Ruge Max, Gill Ahmad, Du-Fay-de-Lavallaz Jeanne M, Rabin Perry, Gomez Joanne Michelle Dumlao, Williams Kim, Rao Anupama, Volgman Annabelle Santos, Marinescu Karolina, Suboc Tisha Marie
机构信息
Rush University Medical Center, Chicago, IL, United States.
Thomas Jefferson University Hospital, Philadelphia, PA, United States.
出版信息
Am Heart J Plus. 2023 Sep 16;34:100324. doi: 10.1016/j.ahjo.2023.100324. eCollection 2023 Oct.
STUDY OBJECTIVE
Study the clinical outcomes associated with the number of concomitant vasopressors used in critically ill COVID-19 patients.
DESIGN
A single-center retrospective cohort study was conducted on patients admitted with COVID-19 to the intensive care unit (ICU) between March and October 2020.
SETTING
Rush University Medical Center, United States.
PARTICIPANTS
Adult patients at least 18 years old with COVID-19 with continuous infusion of any vasopressors were included.
MAIN OUTCOME MEASURES
60-day mortality in COVID-19 patients by the number of concurrent vasopressors received.
RESULTS
A total of 637 patients met our inclusion criteria, of whom 338 (53.1 %) required the support of at least one vasopressor. When compared to patients with no vasopressor requirement, those who required 1 vasopressor (V1) (adjusted odds ratio [aOR] 3.27, 95 % confidence interval (CI) 1.86-5.79, p < 0.01) (n = 137), 2 vasopressors (V2) (aOR 4.71, 95 % CI 2.54-8.77, p < 0.01) (n = 86), 3 vasopressors (V3) (aOR 26.2, 95 % CI 13.35-53.74 p < 0.01) (n = 74), and 4 or 5 vasopressors(V4-5) (aOR 106.38, 95 % CI 39.17-349.93, p < 0.01) (n = 41) were at increased risk of 60-day mortality. In-hospital mortality for patients who received no vasopressors was 6.7 %, 22.6 % for V1, 27.9 % for V2, 62.2 % for V3, and 78 % for V4-V5.
CONCLUSION
Critically ill patients with COVID-19 requiring vasopressors were associated with significantly higher 60-day mortality.
研究目的
研究危重症新型冠状病毒肺炎（COVID-19）患者使用血管活性药物的数量与临床结局之间的关系。
设计
对2020年3月至10月间收治于重症监护病房（ICU）的COVID-19患者进行单中心回顾性队列研究。
地点
美国拉什大学医学中心。
参与者
纳入年龄至少18岁、正在持续输注任何血管活性药物的COVID-19成年患者。
主要观察指标
根据接受的血管活性药物数量，统计COVID-19患者60天死亡率。
结果
共有637例患者符合纳入标准，其中338例（53.1%）需要至少一种血管活性药物支持。与无需血管活性药物的患者相比，需要1种血管活性药物（V1）（校正比值比[aOR] 3.27，95%置信区间[CI] 1.86 - 5.79，p < 0.01）（n = 137）、2种血管活性药物（V2）（aOR 4.71，95% CI 2.54 - 8.77，p < 0.01）（n = 86）、3种血管活性药物（V3）（aOR 26.2，95% CI 13.35 - 53.74，p < 0.01）（n = 74）以及4或5种血管活性药物（V4 - 5）（aOR 106.38，95% CI 39.17 - 349.93，p < 0.01）（n = 41）的患者60天死亡风险增加。未接受血管活性药物治疗的患者院内死亡率为6.7%，V1组为22.6%，V2组为27.9%，V3组为62.2%，V4 - V5组为78%。
结论
需要血管活性药物支持的危重症COVID-19患者60天死亡率显著更高。
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