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重症监护病房中药物性电解质紊乱的评估:一项多中心观察性研究。

Assessment of drug-induced electrolyte disorders in intensive care units: a multicenter observational study.

作者信息

Ayhan Yunus Emre, İlerler Enes Emir, Sosyal Damla, Bektay Muhammed Yunus, Karakurt Sait, Daşkaya Hayrettin, Karaaslan Kazım, Sancar Mesut

机构信息

Department of Clinical Pharmacy, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Türkiye.

Department of Clinical Pharmacy, Marmara University Faculty of Pharmacy, Istanbul, Türkiye.

出版信息

Front Med (Lausanne). 2024 Jun 4;11:1343483. doi: 10.3389/fmed.2024.1343483. eCollection 2024.

Abstract

OBJECTIVE

Electrolyte disorder (ED) is frequently encountered critically ill patients during admission or admission to the intensive care unit (ICU). This study aimed to determine the frequency of ED encountered in ICU patients to evaluate the relationship of ED with drugs.

METHODS

This prospective, multicenter study was conducted in the medical and anesthesiology ICUs of two training and research hospitals and included patients with at least one ED during admission or hospitalization in the ICUs. The relationship between ED and the drug was evaluated by calculating the logistic probabilistic method scale (LPMS) and the expert panel's evaluation. The correlation between EDs and LPMS was determined using Kendal tau. A binary logistic regression model was preferred in the analysis of factors related to ED. Statistical significance was set as  < 0.05.

RESULTS

A total of 117 patients were included in the study. A total of 165 EDs were detected, including at least one in 88 (75.2%) patients. According to the expert panel, 61 (21.7%) of EDs were drug-related, whereas according to the LPMS, 111 (39.6%) ( < 0.001). Mortality (50% vs. 13.7%) and mechanical ventilation rates (52.2% vs. 17.2%) were significantly higher in patients with ED ( < 0.001). Patients with ED had 8.352 times higher odds of exhibiting mortality (OR: 8.352, %95 CI: 1.598-43.648, : 0.012) and need mechanical ventilation with higher odds of 3.229 (OR: 3.229 95% CI: 0.815-12.787 : 0.045). Patient who required enteral or parenteral feeding were associated with an increased likelihood of exhibiting ED (respectively OR: 30.057, %95 CI: 2.265-398.892, : 0.01, OR: 5.537, %95 CI: 1.406-21.800, : 0.014).

CONCLUSION

EDs are very common in the ICU. Dysnatremia was detected more commonly in other EDs. It has also been found that patients with ED are more often under mechanical ventilation, have more prolonged hospitalizations, and have higher mortality rates than patients without ED. The suitability of LPMS for assessing ED-drug relationships in the ICU context is questioned.

摘要

目的

电解质紊乱(ED)在危重症患者入院期间或入住重症监护病房(ICU)时经常出现。本研究旨在确定ICU患者中ED的发生率,以评估ED与药物的关系。

方法

这项前瞻性、多中心研究在两家培训和研究医院的内科及麻醉科ICU进行,纳入在ICU入院或住院期间至少发生一次ED的患者。通过计算逻辑概率法量表(LPMS)和专家小组评估来评估ED与药物之间的关系。使用肯德尔tau检验确定ED与LPMS之间的相关性。在分析与ED相关的因素时,首选二元逻辑回归模型。统计学显著性设定为<0.05。

结果

本研究共纳入117例患者。共检测到165次ED,其中88例(75.2%)患者至少发生一次。根据专家小组的意见,61次(21.7%)ED与药物相关,而根据LPMS,这一比例为111次(39.6%)(<0.001)。ED患者的死亡率(50%对13.7%)和机械通气率(52.2%对17.2%)显著更高(<0.001)。ED患者出现死亡的几率高8.352倍(OR:8.352,95%CI:1.598 - 43.648,P:0.012),需要机械通气的几率高3.229倍(OR:3.229,95%CI:0.815 - 12.787,P:0.045)。需要肠内或肠外营养的患者发生ED的可能性增加(分别为OR:30.057,95%CI:2.265 - 398.892,P:0.01;OR:5.537,95%CI:1.406 - 21.800,P:0.014)。

结论

ED在ICU中非常常见。在其他ED中,低钠血症的检测更为常见。还发现,与无ED的患者相比,ED患者更常接受机械通气,住院时间更长,死亡率更高。LPMS在ICU环境中评估ED与药物关系的适用性受到质疑。

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