Liu Jian, Peng Bin, Huang Biao, Xu Fang, Luo Renjie
Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.
Department of Critical Care Medicine, Youyang Hospital, A Branch of The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.
Sci Rep. 2025 May 30;15(1):19100. doi: 10.1038/s41598-025-04793-9.
To analyze dynamic patterns of arterial carbon dioxide partial pressure (PaCO₂) using latent class growth analysis in acute brain injury patients and investigate their associations with 28-day ICU mortality and 60-day in-hospital mortality. This retrospective study utilized the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We applied latent class growth analysis to analyze PaCO₂ dynamic patterns during the first 72 h after ICU admission in adult patients with acute brain injury. Associations between trajectories and outcomes were evaluated using Cox proportional hazards models. Among the included acute brain injury patients (n = 1,145), three distinct PaCO₂ trajectories were identified: persistent hypocapnia pattern (23.7%), normal-mild regulation pattern (65.9%), and hypercapnia improvement pattern (10.5%). Cox proportional hazards regression analysis revealed that, compared with the normal-mild regulation pattern, the persistent hypocapnia pattern was significantly associated with higher risk of 28-day ICU mortality (HR = 1.28, 95% CI: 1.02-1.60) and 60-day in-hospital mortality (HR = 1.28, 95% CI: 1.03-1.59) after adjusting for confounding factors. The hypercapnia improvement pattern demonstrated a potentially protective association. This study identified distinct patterns of PaCO₂ dynamic changes in acute brain injury patients. Our analysis demonstrated that persistent hypocapnia was associated with higher risk of 28-day ICU and 60-day in-hospital mortality, while the hypercapnia improvement pattern showed potentially protective association. These results suggest the complexity of PaCO₂ management and the need for more individualized respiratory management strategies.
使用潜在类别增长分析来分析急性脑损伤患者动脉血二氧化碳分压（PaCO₂）的动态模式，并研究其与28天ICU死亡率和60天院内死亡率的相关性。这项回顾性研究使用了重症监护医学信息集市IV（MIMIC-IV）数据库。我们应用潜在类别增长分析来分析成年急性脑损伤患者在ICU入院后72小时内的PaCO₂动态模式。使用Cox比例风险模型评估轨迹与结局之间的相关性。在纳入的急性脑损伤患者（n = 1145）中，确定了三种不同的PaCO₂轨迹：持续性低碳酸血症模式（23.7%）、正常-轻度调节模式（65.9%）和高碳酸血症改善模式（10.5%）。Cox比例风险回归分析显示，与正常-轻度调节模式相比，在调整混杂因素后，持续性低碳酸血症模式与28天ICU死亡率（HR = 1.28，95%CI：1.02 - 1.60）和60天院内死亡率（HR = 1.28，95%CI：1.03 - 1.59）的较高风险显著相关。高碳酸血症改善模式显示出潜在的保护关联。本研究确定了急性脑损伤患者PaCO₂动态变化的不同模式。我们的分析表明，持续性低碳酸血症与28天ICU和60天院内死亡率的较高风险相关，而高碳酸血症改善模式显示出潜在的保护关联。这些结果表明了PaCO₂管理的复杂性以及需要更个体化的呼吸管理策略。
