Department of Thoracic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China.
Department of Respiratory Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China.
Medicine (Baltimore). 2024 Nov 1;103(44):e40310. doi: 10.1097/MD.0000000000040310.
Previous studies have indicated that a higher ventilatory ratio (VR) is associated with mortality. However, it is unknown whether dynamic changes in VR over time affect the prognosis of critically ill patients. This study aims to investigate the significance of VR during the progression of the disease in critically ill patients. The Medical Information Mart for Intensive Care III database was searched to identify critically ill patients. The primary outcome was 30-day mortality. Multivariable Cox regression was used to elucidate the relationship between the VR and mortality. Finally, we employed a generalized additive mixed model to compare trends in VR over time between survivors and non-survivors. A total of 8024 patients were enrolled. Multivariable Cox regression analysis identified a baseline VR ≥1.89 as an independent risk factor predicting 30-day mortality (hazard ratio: 2.10, 95% confidence interval: 1.89-2.33, P < .001) and 90-day mortality (hazard ratio: 2.18, 95% confidence interval: 1.97-2.41, P < .001) after adjusting for potential confounders. In the subgroup analyses, the observed association between VR and 30-day mortality showed consistent direction across most subgroups. The generalized additive mixed model results highlighted that the difference in VR between survivors and non-survivors increased by an average of 0.01 per day after adjusting for several covariates. In conclusion, VR dynamically mirrors pathophysiological changes in critically ill patients and its escalation is linked to higher mortality rates. Monitoring VR's dynamic shifts might offer more immediate prognostic information, thus aiding in timely interventions and risk stratification.
先前的研究表明，较高的通气比（VR）与死亡率相关。然而，目前尚不清楚 VR 随时间的动态变化是否会影响危重症患者的预后。本研究旨在探讨 VR 在危重症患者疾病进展过程中的意义。通过检索 Medical Information Mart for Intensive Care III 数据库来识别危重症患者。主要结局是 30 天死亡率。多变量 Cox 回归用于阐明 VR 与死亡率之间的关系。最后，我们采用广义加性混合模型比较幸存者和非幸存者之间 VR 随时间的变化趋势。共纳入 8024 例患者。多变量 Cox 回归分析确定基线 VR≥1.89 是预测 30 天死亡率（危险比：2.10，95%置信区间：1.89-2.33，P<0.001）和 90 天死亡率（危险比：2.18，95%置信区间：1.97-2.41，P<0.001）的独立危险因素，校正了潜在混杂因素后。在亚组分析中，VR 与 30 天死亡率之间的观察到的相关性在大多数亚组中均保持一致的方向。广义加性混合模型结果突出表明，在调整了几个协变量后，幸存者和非幸存者之间 VR 的差异每天平均增加 0.01。总之，VR 动态反映了危重症患者的病理生理变化，其升高与更高的死亡率相关。监测 VR 的动态变化可能提供更即时的预后信息，从而有助于及时干预和风险分层。
