Huang Hongyu, Li Qifei, Lin Qingming, Gong Zheng, Chen Lujia, Chen Feng, Liao Xing, Lin Shirong
Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.
Department of Emergency, Fujian Provincial Hospital, Fuzhou, Fujian, China.
Front Pharmacol. 2024 Jul 23;15:1414809. doi: 10.3389/fphar.2024.1414809. eCollection 2024.
This study aimed to investigate whether dexmedetomidine provides survival benefit in critically ill patients with sepsis-induced coagulopathy (SIC). Patients with sepsis-induced coagulopathy admitted to the ICU were identified from the Medical Information Marketplace for Intensive Care (MIMIC)-IV database. They were divided into two groups: patients who started dexmedetomidine within 48 h of ICU admission and lasted for more than 4 h and patients who did not receive dexmedetomidine as a control group. The primary outcome was 28-day hospital mortality, the secondary outcome was in-hospital mortality, and the extended outcomes included duration of mechanical ventilation and vasopressor use, ICU stay, and hospital stay. Propensity score matching (PSM) analysis was used to match patients who received dexmedetomidine with those who did not, and multivariable Cox models and logistics models were used to account for baseline differences and unmeasured confounders. An external validation was performed with the Critical care database comprising patients with infection at Zigong Fourth People's Hospital. After PSM, 592 patients who received dexmedetomidine were matched with 592 patients who did not receive dexmedetomidine. In the primary and secondary endpoints, dexmedetomidine was associated with a lower risk of 28-day hospital mortality (19.3% vs. 14.2%, hazard ratio (HR) 0.71; P = 0.020) and in-hospital mortality (22.3% vs. 16.4%, odds ratio (OR) 0.68; P = 0.017) in patients with SIC. Regarding the extended outcome, dexmedetomidine was also associated with a longer length of hospital stay (median 12.54 days vs. 14.87 days, P = 0.002) and longer ICU stay (median 5.10 days vs. 6.22 days, P = 0.009). In addition, the duration of mechanical ventilation was significantly increased in the dexmedetomidine group (median 41.62 h vs. 48.00 h, = 0.022), while the duration of vasopressor use was not significantly different (median 36.67 h vs. 39.25 h, = 0.194). Within 48 h of ICU stay, receiving a dose of dexmedetomidine greater than 0.474 μg/kg/h and continuous dexmedetomidine administration for 24-48 h may be associated with 28-day hospitalization outcomes in patients with SIC. External cohort validation also found that the use of dexmedetomidine after admission to the ICU can reduce 28-day mortality in patients with SIC. Dexmedetomidine administration is associated with reduced 28-day hospital mortality and in-hospital mortality in critically ill patients with SIC, and these findings deserve further verification in randomized controlled trials.
本研究旨在调查右美托咪定是否能为脓毒症诱导的凝血病（SIC）重症患者带来生存益处。从重症监护医学信息市场（MIMIC）-IV数据库中识别出入住重症监护病房（ICU）的脓毒症诱导凝血病患者。他们被分为两组：在ICU入院后48小时内开始使用右美托咪定且持续超过4小时的患者，以及未接受右美托咪定的患者作为对照组。主要结局是28天医院死亡率，次要结局是住院死亡率，扩展结局包括机械通气和血管升压药使用时长、ICU住院时间和住院时间。采用倾向评分匹配（PSM）分析将接受右美托咪定的患者与未接受右美托咪定的患者进行匹配，并使用多变量Cox模型和逻辑模型来考虑基线差异和未测量的混杂因素。使用自贡市第四人民医院感染患者的重症监护数据库进行外部验证。PSM后，592例接受右美托咪定的患者与592例未接受右美托咪定的患者进行了匹配。在主要和次要终点方面，右美托咪定与SIC患者28天医院死亡率（19.3%对14.2%，风险比（HR）0.71；P = 0.020）和住院死亡率（22.3%对16.4%，比值比（OR）0.68；P = 0.017）较低的风险相关。关于扩展结局，右美托咪定还与更长的住院时间（中位数12.54天对14.87天，P = 0.002）和更长的ICU住院时间（中位数5.10天对6.22天，P = 0.009）相关。此外，右美托咪定组机械通气时长显著增加（中位数41.62小时对48.00小时，P = 0.022），而血管升压药使用时长无显著差异（中位数36.67小时对39.25小时，P = 0.194）。在ICU住院48小时内，接受剂量大于0.474μg/kg/h的右美托咪定并持续使用24 - 48小时可能与SIC患者的28天住院结局相关。外部队列验证也发现ICU入院后使用右美托咪定可降低SIC患者的28天死亡率。对于SIC重症患者，使用右美托咪定与降低28天医院死亡率和住院死亡率相关，这些发现值得在随机对照试验中进一步验证。
