Zhang Kai, Shi Yu, Han Yu, Cai Tian Yi, Gu Fang Ming, Gu Zhao Xuan, Zhang Tianqi, Huang Mao Xun
The Second Hospital of Jilin University, Changchun, China.
Department of Ophthalmology, First Hospital of Jilin University, Changchun, China.
Dose Response. 2024 Dec 2;22(4):15593258241303040. doi: 10.1177/15593258241303040. eCollection 2024 Oct-Dec.
While respiratory rate has proven to be a sensitive prognostic indicator in ICU settings, its relevance in the context of Acute Myocardial Infarction (AMI) patients complicated by Congestive Heart Failure (CHF) remains underexplored. Therefore, this study aims to investigate the relationship between respiratory rate and in-hospital mortality in this specific patient cohort. This retrospective cohort study utilized the Medical Information Mart for Intensive Care-IV database to analyze all AMI patients with concomitant CHF. The primary outcome, in-hospital mortality, was assessed through multivariate analysis. Logistic regression models, restricted cubic spline regression models, and subgroup analyses were employed to explore the association between respiratory rate and in-hospital mortality. The study encompassed 5056 participants diagnosed with both CHF and AMI. After adjusting for confounding variables, each incremental unit rise in respiratory rate was associated with an 8% increase in the risk of patient mortality (OR = 1.08, 95% CI: 1.05∼1.11, < 0.001). When comparing individuals with respiratory rates in the first tertile (≤17 breaths per minute) and the third tertile (>17-20 breaths per minute) to those in the second tertile (17-20 breaths per minute), the adjusted ORs for in-hospital mortality were 1.09 (95% CI: 0.82∼1.46, = 0.546) and 1.62 (95% CI: 1.27∼2.06, < 0.001), respectively. A dose-response relationship depicted a J-shaped curve between respiratory rate and the risk of in-hospital mortality, with an inflection point at approximately 19 breaths per minute. Stratified analyses confirmed the robustness of this correlation. This study reveals a J-shaped association between respiratory rate and in-hospital mortality in ICU patients suffering from both AMI and CHF.
虽然呼吸频率已被证明是重症监护病房环境中的一个敏感预后指标，但其在并发充血性心力衰竭（CHF）的急性心肌梗死（AMI）患者中的相关性仍未得到充分研究。因此，本研究旨在调查这一特定患者群体中呼吸频率与院内死亡率之间的关系。这项回顾性队列研究利用重症监护医学信息集市-IV数据库分析了所有合并CHF的AMI患者。通过多变量分析评估主要结局——院内死亡率。采用逻辑回归模型、受限立方样条回归模型和亚组分析来探讨呼吸频率与院内死亡率之间的关联。该研究纳入了5056名被诊断为CHF和AMI的参与者。在调整混杂变量后，呼吸频率每增加一个单位，患者死亡风险就增加8%（OR = 1.08，95% CI：1.05∼1.11，<0.001）。将呼吸频率处于第一三分位数（≤17次/分钟）和第三三分位数（>17 - 20次/分钟）的个体与处于第二三分位数（17 - 20次/分钟）的个体进行比较时，院内死亡率的调整OR分别为1.09（95% CI：0.82∼1.46， = 0.546）和1.62（95% CI：1.27∼2.06，<0.001）。剂量反应关系描绘了呼吸频率与院内死亡风险之间的J形曲线，拐点约为19次/分钟。分层分析证实了这种相关性的稳健性。本研究揭示了在患有AMI和CHF的重症监护病房患者中，呼吸频率与院内死亡率之间存在J形关联。
