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Benzodiazepine and z-drug prescribing in critical care survivors and the risk of rehospitalisation or death due to falls/trauma and due to any cause: a retrospective matched cohort study using the UK Clinical Practice Research Datalink.

作者信息

Mansi Elizabeth T, Rentsch Christopher T, Bourne Richard S, Jeffery Annie, Guthrie Bruce, Lone Nazir I

机构信息

Usher Institute, University of Edinburgh, Edinburgh, UK.

Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.

出版信息

Intensive Care Med. 2025 Jan;51(1):125-136. doi: 10.1007/s00134-024-07762-4. Epub 2025 Jan 7.


DOI:10.1007/s00134-024-07762-4
PMID:39774867
Abstract

PURPOSE: Benzodiazepines and z-drugs are often prescribed to critical care survivors due to high prevalence of mental health problems and insomnia. However, their safety has not been studied in this population. METHODS: Retrospective cohort study of 28,678 adult critical care survivors hospitalised in 2010 and 2018: 4844 prescribed benzodiazepines or z-drugs, matched to 23,834 unexposed survivors using UK Clinical Practice Research Datalink linked datasets. Multivariable stratified Cox regression was used to estimate the adjusted hazards ratio (adjHR) with 95% confidence intervals (CI) of community benzodiazepine/z-drug prescribing and falls/trauma-related events, as well as all-cause 30-day rehospitalisation or death. We performed subgroup analyses on patients without pre-critical care admission prescription of benzodiazepines/z-drugs ('treatment-naïve'), and sensitivity analyses excluding patients receiving palliative care after discharge. RESULTS: Prescription of benzodiazepines or z-drugs showed no conclusive evidence of increased risk of falls/trauma-related events in the whole cohort (adjHR 1.27; 95%CI 0.76-2.14) or in treatment-naïve individuals (adjHR 1.79; 95%CI 0.61-5.26), because estimates lacked precision due to low event rates. For all-cause rehospitalisation or death, benzodiazepines/z-drugs were associated with increased risk (whole cohort adjHR 1.24, 95%CI 1.14-1.36; treatment-naïve adjHR 1.66, 95%CI 1.49-1.86). However, after excluding patients treated for palliative care, the association persisted only in treatment-naïve individuals (whole cohort adjHR 1.08, 95%CI 0.98-1.19; treatment-naïve adjHR 1.42, 95%CI1.25-1.62). CONCLUSIONS: Community benzodiazepine and z-drug prescribing was associated with increased risk of all-cause, but not falls/trauma-related, rehospitalisations and deaths in critical care survivors who had not been prescribed these before hospitalisation. Clinicians should balance the possible benefits with the likely harms of prescribing these drugs in this potentially vulnerable patient group.

摘要

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[1]
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[2]
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本文引用的文献

[1]
Patient Characteristics and Practice Variation Associated With New Community Prescription of Benzodiazepine and z-Drug Hypnotics After Critical Illness: A Retrospective Cohort Study Using the UK Clinical Practice Research Datalink.

Pharmacoepidemiol Drug Saf. 2024-12

[2]
Association between critical care admission and chronic medication discontinuation post-hospital discharge: A retrospective cohort study.

J Intensive Care Soc. 2024-3-1

[3]
Onset of Prolonged High-Potency Benzodiazepine Use Among ICU Survivors: A Nationwide Cohort Study.

Crit Care Explor. 2024-7

[4]
Risk of adverse outcomes during gabapentinoid therapy and factors associated with increased risk in UK primary care using the clinical practice research datalink: a cohort study.

Pain. 2024-10-1

[5]
Do critical illness survivors with multimorbidity need a different model of care?

Crit Care. 2023-12-8

[6]
Critical Care Staffing in Pandemics and Disasters: A Consensus Report From a Subcommittee of the Task Force for Mass Critical Care - Systems Strategies to Sustain the Health Care Workforce.

Chest. 2023-7

[7]
Predictive factors for severe long-term chronic kidney disease after acute kidney injury requiring renal replacement therapy in critically ill patients: an ancillary study of the ELVIS randomized controlled trial.

Crit Care. 2022-11-29

[8]
Predictors of falls and fractures leading to hospitalisation in 36 101 people with affective disorders: a large representative cohort study.

BMJ Open. 2022-3-11

[9]
Benzodiazepines and Related Sedatives.

Med Clin North Am. 2022-1

[10]
The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: a prospective cohort study.

Crit Care. 2021-11-8

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