Deng Yanhui, Wang Shaoxiang, Zhou Shaohua, Zhao Wan, Wang Aitian, Gao Jingli
Department of Intensive Medicine, Kailuan General Hospital, Tangshan, China.
Hebei North University School of Graduate Studies, Zhangjiakou, China.
Front Pharmacol. 2025 Aug 29;16:1663974. doi: 10.3389/fphar.2025.1663974. eCollection 2025.
Long-acting glucocorticoids are frequently administered in the intensive care unit (ICU); however, their precise effect on ICU mortality in septic patients with acute respiratory failure remains inadequately defined. This study aims to investigate whether the use of long-acting glucocorticoids is associated with a reduced mortality rate in this critically ill population.
Adult patients meeting the Sepsis-3 criteria and simultaneously experiencing acute respiratory failure were retrospectively identified from version 3.0 of the MIMIC-IV (Medical Information Mart for Intensive Care) database. The primary outcome of interest was ICU mortality, defined as death occurring before discharge from the intensive care unit. To minimize baseline confounding, propensity score matching was performed at a 1:3 ratio using nearest-neighbor matching with a caliper width of 0.2 standard deviations. Time-to-event analyses were conducted using Kaplan-Meier survival curves, with statistical significance evaluated via log-rank testing. Additionally, a multivariable Cox proportional hazards regression model was employed to adjust for illness severity and treatment-related covariates, with further exploratory subgroup analyses performed to assess potential effect modifications.
This study analyzed a cohort of 10,707 patients diagnosed in Septic Patients with Acute Respiratory Failure, among whom 2,298 (21.5%) succumbed to ICU mortality. Patients were stratified into glucocorticoid-exposed and unexposed groups based on documented administration of long-acting glucocorticoids during ICU treatment. The crude mortality rate was higher in the unexposed group compared to the glucocorticoid-exposed cohort, and this association remained statistically significant after adjustment in multivariable Cox regression analyses (HR 1.22, 95% CI 1.04-1.43). Subgroup analyses identified significant interaction effects, particularly among patients with malignancies and those receiving continuous renal replacement therapy. Furthermore, propensity score-matched analyses reinforced the primary findings, demonstrating consistent mortality differences between the groups. Sensitivity analysis of different treatment groups showed that the long-acting glucocorticoid group had a significant survival advantage compared to the short-acting glucocorticoid group.
The use of long-acting glucocorticoids was correlated with a reduction in ICU mortality among critically ill by septic patients with acute respiratory failure. This finding indicates a potential survival advantage associated with long-acting glucocorticoid therapy in this high-risk patient population.
长效糖皮质激素在重症监护病房（ICU）中经常使用；然而，其对患有急性呼吸衰竭的脓毒症患者的ICU死亡率的确切影响仍未得到充分界定。本研究旨在调查在这一危重症人群中使用长效糖皮质激素是否与死亡率降低相关。
从MIMIC-IV（重症监护医学信息集市）数据库3.0版本中回顾性识别出符合脓毒症-3标准且同时患有急性呼吸衰竭的成年患者。感兴趣的主要结局是ICU死亡率，定义为在重症监护病房出院前发生的死亡。为尽量减少基线混杂因素，采用倾向评分匹配法，以1:3的比例进行最近邻匹配，卡尺宽度为0.2个标准差。使用Kaplan-Meier生存曲线进行事件发生时间分析，并通过对数秩检验评估统计学显著性。此外，采用多变量Cox比例风险回归模型对疾病严重程度和治疗相关协变量进行调整，并进行进一步的探索性亚组分析以评估潜在的效应修饰。
本研究分析了一组10707例被诊断为急性呼吸衰竭脓毒症患者的队列，其中2298例（21.5%）死于ICU。根据ICU治疗期间长效糖皮质激素的记录使用情况，将患者分为糖皮质激素暴露组和未暴露组。未暴露组的粗死亡率高于糖皮质激素暴露队列，在多变量Cox回归分析调整后，这种关联仍具有统计学显著性（HR 1.22，95%CI 1.04-1.43）。亚组分析确定了显著的交互作用，特别是在恶性肿瘤患者和接受持续肾脏替代治疗的患者中。此外，倾向评分匹配分析强化了主要发现，表明两组之间存在一致的死亡率差异。不同治疗组的敏感性分析表明，长效糖皮质激素组与短效糖皮质激素组相比具有显著的生存优势。
在患有急性呼吸衰竭的脓毒症危重症患者中，使用长效糖皮质激素与ICU死亡率降低相关。这一发现表明在这一高危患者群体中，长效糖皮质激素治疗具有潜在的生存优势。
