Yi Xiao-Qing, Xie Bo, Hu Yuan, Gong Tian-Jiao, Chen Min, Cui Xiao-Jiao
Department of Pharmacy, Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Department of Cardiology, Chengdu First People's Hospital, Chengdu, China.
Front Pharmacol. 2024 Aug 12;15:1445975. doi: 10.3389/fphar.2024.1445975. eCollection 2024.
Acetaminophen is a commonly used medication, yet its recommendation for patients with comorbid conditions of gout and hypertension is contradictory, and the impact of its usage on clinical outcomes in real-world practical settings remains uncertain. The aim of this study was to investigate the association between acetaminophen administration and clinical outcomes in critically ill patients with gout and hypertension, utilizing real-world data.
A retrospective cohort study was conducted based on the MIMIC-IV (Medical Information Mart in Intensive Care-IV) database. Adult critically ill patients with gout and hypertension were included in the analysis. The exposure was acetaminophen use during ICU stay. The primary outcome was in-hospital mortality. The secondary endpoints were frequent hospitalization, 30-day, and 60-day all-cause mortality, and incidence of hypertensive emergencies. Propensity score matching (PSM) was conducted at a 1:1 ratio. Multivariable analyses were used to adjust for confounders.
The pre-matched and propensity score-matched cohorts included 2448 and 1012 patients, respectively. In the PSM analysis, in-hospital mortality was 9.7% (49/506) in the acetaminophen use group and 12.1% (61/506) in the no use group. Acetaminophen use was associated with a decrease in-hospital mortality (hazard ratio [HR], 0.62; 95% CI, 0.41-0.92; = 0.018). In terms of secondary endpoints, after PSM, there was no statistically significant difference for both 30-day and 60-day all-cause mortality reductions in the acetaminophen use group, and HRs were 0.78 (95% CI 0.55-1.11; = 0.175), and 0.75 (95% CI 0.55-1.02; = 0.069), respectively. According to the analysis of dosage and treatment group, the use of APAP within the dosage range of 2-4 g and within 3-5 days of treatment significantly reduced the mortality rate of the entire cohort and PSM cohort, with statistical differences. Subgroup analysis demonstrated that lower in-hospital mortality was consistent across different baselines (age, gender, BMI, liver disease, and renal disease), with no interactions in all subgroups (interaction -values >0.05), thereby affirming the robustness and reliability of the findings.
Acetaminophen use was associated with lower in-hospital mortality in critically ill patients with gout and hypertension. Prospective studies are needed to verify this finding.
对乙酰氨基酚是一种常用药物，然而对于患有痛风和高血压合并症的患者，其用药建议存在矛盾，并且在实际临床环境中其使用对临床结局的影响仍不明确。本研究的目的是利用真实世界数据，调查对乙酰氨基酚给药与患有痛风和高血压的重症患者临床结局之间的关联。
基于MIMIC-IV（重症监护医学信息数据库-IV）数据库进行了一项回顾性队列研究。纳入分析的是患有痛风和高血压的成年重症患者。暴露因素为在重症监护病房（ICU）住院期间使用对乙酰氨基酚。主要结局是院内死亡率。次要终点是频繁住院、30天和60天全因死亡率以及高血压急症的发生率。以1:1的比例进行倾向评分匹配（PSM）。采用多变量分析来调整混杂因素。
匹配前和倾向评分匹配后的队列分别包括2448例和1012例患者。在PSM分析中，对乙酰氨基酚使用组的院内死亡率为9.7%（49/506），未使用组为12.1%（61/506）。使用对乙酰氨基酚与降低院内死亡率相关（风险比[HR]，0.62；95%置信区间，0.41 - 0.92；P = 0.018）。就次要终点而言，PSM后，对乙酰氨基酚使用组在30天和60天全因死亡率降低方面均无统计学显著差异，HR分别为0.78（95%置信区间0.55 - 1.11；P = 0.175）和 0.75（95%置信区间0.55 - 1.02；P = 0.069）。根据剂量和治疗组分析，在2 - 4克剂量范围内以及治疗3 - 5天内使用对乙酰氨基酚显著降低了整个队列和PSM队列的死亡率，具有统计学差异。亚组分析表明，不同基线（年龄､性别､体重指数､肝病和肾病）下较低的院内死亡率是一致的，所有亚组均无相互作用（相互作用P值>0.05），从而证实了研究结果的稳健性和可靠性。
在患有痛风和高血压的重症患者中，使用对乙酰氨基酚与较低的院内死亡率相关。需要进行前瞻性研究来验证这一发现。
