Institute for Global Health, University College London, London, United Kingdom.
First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China.
Front Public Health. 2024 Mar 27;12:1368508. doi: 10.3389/fpubh.2024.1368508. eCollection 2024.
Alzheimer's disease (AD) is increasingly recognized as a pressing global public health issue, demanding urgent development of scientific AD management strategies. In recent years, the proportion of AD patients in Intensive Care Units (ICU) has been on the rise. Simultaneously, the use of mechanical ventilation (MV) is becoming more prevalent among this specific patient group. Considering the pathophysiological characteristics of AD, the application of MV in AD patients may lead to different outcomes. However, due to insufficient research data, the significant impact of MV on the prognosis of AD patients in the ICU remains unclear. Therefore, we conducted this study to comprehensively evaluate the potential influence of MV on the survival rate of AD patients in the ICU.
We obtained data from the MIMIC-IV database for patients diagnosed with AD. Using propensity score matching (PSM), we paired patients who received MV treatment with those who did not receive treatment. Next, we conducted Cox regression analysis to evaluate the association between MV and in-hospital mortality, 7-day mortality, 28-day mortality, 90-day mortality, 4-year mortality, length of hospital stay, and ICU stay.
The data analysis involved a cohort of 641 AD patients spanning from 2008 to 2019, inclusive. Following a 1:2 propensity score matching (PSM) procedure, 300 patients were successfully paired, comprising 123 individuals who underwent MV treatment and 177 who did not. MV demonstrated an association with an elevated risk of in-hospital mortality (HR 5.782; 95% CI 2.981-11.216; < 0.001), 7-day mortality (HR 6.353; 95% CI 3.014-13.392; < 0.001), 28-day mortality (HR 3.210; 95% CI 1.977-5.210; < 0.001), 90-day mortality (HR 2.334; 95% CI 1.537-3.544; < 0.001), and 4-year mortality (HR 1.861; 95% CI 1.370-2.527; < 0.001). Furthermore, it was associated with a prolonged length of ICU stay [3.6(2.2,5.8) vs. 2.2(1.6,3.7); = 0.001]. In the subgroup analysis, we further confirmed the robustness of the results obtained from the overall population. Additionally, we observed a significant interaction (-interaction <0.05) between age, admission type, aspirin use, statin use, and the use of MV.
In patients with AD who are receiving treatment in the ICU, the use of MV has been linked to higher short-term, medium-term, and long-term mortality rates, as well as prolong ICU stays. Therefore, it is crucial to break away from conventional thinking and meticulously consider both the medical condition and personal preferences of these vulnerable patients. Personalized treatment decisions, comprehensive communication between healthcare providers and patients, formulation of comprehensive treatment plans, and a focus on collaboration between the ICU and community organizations become imperative.
阿尔茨海默病（AD）日益被视为全球紧迫的公共卫生问题，急需制定科学的 AD 管理策略。近年来，重症监护病房（ICU）中 AD 患者的比例呈上升趋势。同时，这一特定患者群体中使用机械通气（MV）的情况也越来越普遍。鉴于 AD 的病理生理学特征，MV 在 AD 患者中的应用可能会导致不同的结果。然而，由于研究数据不足，MV 对 ICU 中 AD 患者预后的显著影响仍不清楚。因此，我们进行了这项研究，以全面评估 MV 对 ICU 中 AD 患者生存率的潜在影响。
我们从 MIMIC-IV 数据库中获取了诊断为 AD 的患者数据。使用倾向评分匹配（PSM），我们将接受 MV 治疗的患者与未接受治疗的患者进行配对。然后，我们进行 Cox 回归分析，评估 MV 与院内死亡率、7 天死亡率、28 天死亡率、90 天死亡率、4 年死亡率、住院时间和 ICU 停留时间之间的关联。
数据分析涉及 2008 年至 2019 年期间的 641 名 AD 患者队列。经过 1:2 的倾向评分匹配（PSM）程序，成功配对了 300 名患者，包括 123 名接受 MV 治疗的患者和 177 名未接受治疗的患者。MV 与院内死亡率（HR 5.782；95%CI 2.981-11.216； < 0.001）、7 天死亡率（HR 6.353；95%CI 3.014-13.392； < 0.001）、28 天死亡率（HR 3.210；95%CI 1.977-5.210； < 0.001）、90 天死亡率（HR 2.334；95%CI 1.537-3.544； < 0.001）和 4 年死亡率（HR 1.861；95%CI 1.370-2.527； < 0.001）显著相关。此外，它与 ICU 停留时间延长相关[3.6(2.2,5.8) vs. 2.2(1.6,3.7)； = 0.001]。在亚组分析中，我们进一步证实了从总体人群中获得的结果的稳健性。此外，我们观察到年龄、入院类型、阿司匹林使用、他汀类药物使用和 MV 使用之间存在显著的交互作用（-交互作用<0.05）。
在 ICU 中接受治疗的 AD 患者中，MV 的使用与较高的短期、中期和长期死亡率以及 ICU 停留时间延长相关。因此，必须摒弃传统思维，仔细考虑这些脆弱患者的医疗状况和个人偏好。个性化的治疗决策、医疗保健提供者与患者之间的全面沟通、制定全面的治疗计划以及注重 ICU 和社区组织之间的合作变得至关重要。
