Wan Jin, Cao Xiaoyu, Yang Yaran
Rheumatology and Immunology Department, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No. 119, West South Fourth Ring Road, 100070, Beijing, China.
Clin Rheumatol. 2025 Feb;44(2):615-622. doi: 10.1007/s10067-024-07280-0. Epub 2024 Dec 24.
Inflammatory response is a natural protective response in infection or injury. The immune imbalance of rheumatoid arthritis (RA) patients and the use of anti-rheumatic immune drugs may affect the inflammatory response process of shock. The evidence of the impact of RA on short-time mortality in shock patients is limited. This study was a retrospective observational study from the Medical Information Mart for Intensive Care IV database (MIMIC-IV). Patients diagnosed with shock were selected from the database. The primary outcome was in-hospital mortality. Binary logistic regression analysis was used to explore the association between RA and in-hospital mortality. Subgroup analysis of the association between in-hospital mortality and RA was performed in septic shock, cardiogenic shock, and other types of shock. A total of 8233 ICU patients with shock were identified. After adjusting for confounding variables, RA was associated with a lower risk of in-hospital mortality (OR, 0.58; 95% CI, 0.38-0.91). The results of the subgroup analysis showed that RA was associated with a decreased risk of in-hospital death in the septic shock group but not in cardiogenic shock or other types of shock. RA was associated with a lower risk of in-hospital death in shock patients. This association was only observed in septic shock but not in cardiogenic shock and other types of shock. Key Points • Rheumatoid arthritis (RA) is associated with a lower risk of in-hospital mortality in ICU patients with shock, particularly in those with septic shock. • This study utilized propensity score matching to accurately compare outcomes between RA and non-RA shock patients, ensuring balanced baseline characteristics. • Findings suggest that the immune modulation inherent to RA or the impact of anti-rheumatic drugs might influence the survival outcomes in shock scenarios. • The protective effect of RA on in-hospital mortality was not observed in patients with cardiogenic shock or other types of shock, indicating a specific interaction in septic shock contexts.
炎症反应是感染或损伤时的一种自然保护反应。类风湿关节炎（RA）患者的免疫失衡以及抗风湿免疫药物的使用可能会影响休克的炎症反应过程。RA对休克患者短期死亡率影响的证据有限。本研究是一项来自重症监护医学信息数据库IV（MIMIC-IV）的回顾性观察研究。从该数据库中选取诊断为休克的患者。主要结局是院内死亡率。采用二元逻辑回归分析探讨RA与院内死亡率之间的关联。对脓毒性休克、心源性休克和其他类型休克中院内死亡率与RA之间的关联进行亚组分析。共确定了8233例ICU休克患者。在调整混杂变量后，RA与较低的院内死亡风险相关（OR，0.58；95%CI，0.38 - 0.91）。亚组分析结果显示，RA与脓毒性休克组院内死亡风险降低相关，但在心源性休克或其他类型休克中并非如此。RA与休克患者较低的院内死亡风险相关。这种关联仅在脓毒性休克中观察到，而在心源性休克和其他类型休克中未观察到。要点 • 类风湿关节炎（RA）与ICU休克患者较低的院内死亡风险相关，尤其是在脓毒性休克患者中。 • 本研究利用倾向评分匹配准确比较RA和非RA休克患者的结局，确保基线特征平衡。 • 研究结果表明，RA固有的免疫调节或抗风湿药物的影响可能会影响休克情况下的生存结局。 • 在心脏性休克或其他类型休克患者中未观察到RA对院内死亡率的保护作用，表明在脓毒性休克情况下存在特定相互作用。
