早期依诺肝素预防性抗凝与慢性阻塞性肺疾病重症患者重症监护病房死亡率的关联：一项基于机器学习的回顾性队列研究

Association of early enoxaparin prophylactic anticoagulation with ICU mortality in critically ill patients with chronic obstructive pulmonary disease: a machine learning-based retrospective cohort study.

作者信息

Lin Shan, Zhang Jing, Dang Xin, Zhan Qingyuan

机构信息

Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.

Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.

出版信息

Front Pharmacol. 2025 May 12;16:1588846. doi: 10.3389/fphar.2025.1588846. eCollection 2025.

DOI:10.3389/fphar.2025.1588846

PMID:40421211

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12104056/

Abstract

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a major contributor to global morbidity and mortality, particularly during acute exacerbations that frequently require intensive care unit (ICU) admissions. Considering the hypercoagulability associated with COPD, which intensifies during acute episodes, prophylactic anticoagulation therapy may help reduce ICU mortality. However, this potential has not been explored specifically in this population of patients.

METHODS

We conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care IV, spanning patient records from 2008 to 2019 at the Beth Israel Deaconess Medical Center in Boston. This study focused on critically ill patients with COPD, employing feature selection methods, to identify key variables influencing clinical outcomes. The impact of prophylactic enoxaparin on prognosis was assessed using logistic regression models and Kaplan-Meier survival analysis.

RESULTS

Our analysis included 4,433 critically ill patients with COPD, of whom 446 received enoxaparin within the first 72 h of ICU admission. The primary analysis showed that patients treated with enoxaparin experienced a 48% lower ICU mortality (odds ratio 0.52 [95% confidence interval 0.31-0.86]) than that of those not treated with enoxaparin, with an E-value of 3.26. This association between enoxaparin use and lower ICU mortality persisted across all subgroups examined. Additionally, a visual analysis of patients with varying Oxford acute severity of illness score (OASIS) indicated that early enoxaparin use was linked to an improved prognosis in critically ill patients with COPD who had higher OASIS than in those without.

CONCLUSION

Early initiation of prophylactic enoxaparin therapy was significantly associated with low ICU mortality in critically ill patients with COPD, especially in high-risk subgroups. These findings support the need for randomized controlled trials to confirm the effectiveness of thromboprophylaxis in this specific patient population and to evaluate the potential bleeding risks.

摘要

背景

慢性阻塞性肺疾病（COPD）是全球发病和死亡的主要原因，尤其是在频繁需要入住重症监护病房（ICU）的急性加重期。考虑到COPD相关的高凝状态在急性发作期间会加剧，预防性抗凝治疗可能有助于降低ICU死亡率。然而，这一潜力尚未在这类患者群体中得到具体研究。

方法

我们进行了一项回顾性队列研究，使用重症监护医学信息数据库IV的数据，涵盖2008年至2019年波士顿贝斯以色列女执事医疗中心的患者记录。本研究聚焦于患有COPD的重症患者，采用特征选择方法来识别影响临床结局的关键变量。使用逻辑回归模型和Kaplan-Meier生存分析评估预防性依诺肝素对预后的影响。

结果

我们的分析纳入了4433例患有COPD的重症患者，其中446例在入住ICU的前72小时内接受了依诺肝素治疗。初步分析显示，接受依诺肝素治疗的患者ICU死亡率比未接受依诺肝素治疗的患者低48%（比值比0.52[95%置信区间0.31 - 0.86]），E值为3.26。在所有检查的亚组中，依诺肝素使用与较低的ICU死亡率之间的这种关联均持续存在。此外，对不同牛津急性疾病严重程度评分（OASIS）患者的可视化分析表明，早期使用依诺肝素与OASIS较高的COPD重症患者的预后改善有关，而OASIS较低的患者则不然。