{"title":"重症脓毒症患者的纵向血管活性肌力评分轨迹及其预后意义:回顾性队列分析","authors":"Shiji Xiao , Qiufeng Zhuang , Yinling Li , Zhibin Xue","doi":"10.1016/j.clinthera.2024.07.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>Sepsis continues to be a critical issue in intensive care, characterized by significant morbidity and mortality. This study explores the association between Vasoactive Inotrope Score (VIS) trajectories and 28-day mortality in ICU patients with sepsis, employing VIS trajectories as a marker for assessing severity and guiding therapy.</p></div><div><h3>Methods</h3><p>We conducted a retrospective analysis of the MIMIC-IV database, which included sepsis patients admitted to the ICU between 2008 and 2019. VIS calculations were performed bi-hourly during the first 72 hours of ICU admission. Using latent growth mixture modeling, we identified distinct VIS trajectory patterns, and multivariate Cox proportional hazards models were employed to evaluate their association with 28-day mortality.</p></div><div><h3>Findings</h3><p>Among 6,802 sepsis patients who met the inclusion criteria, four distinct VIS trajectory patterns were identified: “Low-Decreasing” (52.1%), “Mild-Ascending” (13.2%), “Moderate-Decreasing” (23.0%), and “High-Stable” (11.6%). The 28-day survival analysis demonstrated that, compared to the “Low-Decreasing” group, the “Mild-Ascending” group had a hazard ratio (HR) for mortality of 2.55 (95% CI: 2.19–2.97, <em>P</em> < 0.001), the “Moderate-Decreasing” group had an HR of 1.20 (95% CI: 1.03–1.41, <em>P</em> = 0.021), and the “High-Stable” group presented the highest risk with an HR of 4.19 (95% CI: 3.43–5.12, <em>P</em> < 0.001).</p></div><div><h3>Implications</h3><p>This study offers significant insights into the prognostic value of VIS trajectories in sepsis patients. The identification of distinct trajectory patterns not only underscores the heterogeneity in sepsis but also emphasizes the importance of personalized management strategies. The findings underscore the potential of VIS trajectory monitoring in predicting 28-day outcomes and in guiding clinical decision-making in ICU settings.</p></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 9","pages":"Pages 711-716"},"PeriodicalIF":3.2000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Longitudinal Vasoactive Inotrope Score Trajectories and Their Prognostic Significance in Critically Ill Sepsis Patients: A Retrospective Cohort Analysis\",\"authors\":\"Shiji Xiao , Qiufeng Zhuang , Yinling Li , Zhibin Xue\",\"doi\":\"10.1016/j.clinthera.2024.07.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>Sepsis continues to be a critical issue in intensive care, characterized by significant morbidity and mortality. This study explores the association between Vasoactive Inotrope Score (VIS) trajectories and 28-day mortality in ICU patients with sepsis, employing VIS trajectories as a marker for assessing severity and guiding therapy.</p></div><div><h3>Methods</h3><p>We conducted a retrospective analysis of the MIMIC-IV database, which included sepsis patients admitted to the ICU between 2008 and 2019. VIS calculations were performed bi-hourly during the first 72 hours of ICU admission. Using latent growth mixture modeling, we identified distinct VIS trajectory patterns, and multivariate Cox proportional hazards models were employed to evaluate their association with 28-day mortality.</p></div><div><h3>Findings</h3><p>Among 6,802 sepsis patients who met the inclusion criteria, four distinct VIS trajectory patterns were identified: “Low-Decreasing” (52.1%), “Mild-Ascending” (13.2%), “Moderate-Decreasing” (23.0%), and “High-Stable” (11.6%). The 28-day survival analysis demonstrated that, compared to the “Low-Decreasing” group, the “Mild-Ascending” group had a hazard ratio (HR) for mortality of 2.55 (95% CI: 2.19–2.97, <em>P</em> < 0.001), the “Moderate-Decreasing” group had an HR of 1.20 (95% CI: 1.03–1.41, <em>P</em> = 0.021), and the “High-Stable” group presented the highest risk with an HR of 4.19 (95% CI: 3.43–5.12, <em>P</em> < 0.001).</p></div><div><h3>Implications</h3><p>This study offers significant insights into the prognostic value of VIS trajectories in sepsis patients. The identification of distinct trajectory patterns not only underscores the heterogeneity in sepsis but also emphasizes the importance of personalized management strategies. The findings underscore the potential of VIS trajectory monitoring in predicting 28-day outcomes and in guiding clinical decision-making in ICU settings.</p></div>\",\"PeriodicalId\":10699,\"journal\":{\"name\":\"Clinical therapeutics\",\"volume\":\"46 9\",\"pages\":\"Pages 711-716\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical therapeutics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0149291824002066\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical therapeutics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0149291824002066","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
Longitudinal Vasoactive Inotrope Score Trajectories and Their Prognostic Significance in Critically Ill Sepsis Patients: A Retrospective Cohort Analysis
Purpose
Sepsis continues to be a critical issue in intensive care, characterized by significant morbidity and mortality. This study explores the association between Vasoactive Inotrope Score (VIS) trajectories and 28-day mortality in ICU patients with sepsis, employing VIS trajectories as a marker for assessing severity and guiding therapy.
Methods
We conducted a retrospective analysis of the MIMIC-IV database, which included sepsis patients admitted to the ICU between 2008 and 2019. VIS calculations were performed bi-hourly during the first 72 hours of ICU admission. Using latent growth mixture modeling, we identified distinct VIS trajectory patterns, and multivariate Cox proportional hazards models were employed to evaluate their association with 28-day mortality.
Findings
Among 6,802 sepsis patients who met the inclusion criteria, four distinct VIS trajectory patterns were identified: “Low-Decreasing” (52.1%), “Mild-Ascending” (13.2%), “Moderate-Decreasing” (23.0%), and “High-Stable” (11.6%). The 28-day survival analysis demonstrated that, compared to the “Low-Decreasing” group, the “Mild-Ascending” group had a hazard ratio (HR) for mortality of 2.55 (95% CI: 2.19–2.97, P < 0.001), the “Moderate-Decreasing” group had an HR of 1.20 (95% CI: 1.03–1.41, P = 0.021), and the “High-Stable” group presented the highest risk with an HR of 4.19 (95% CI: 3.43–5.12, P < 0.001).
Implications
This study offers significant insights into the prognostic value of VIS trajectories in sepsis patients. The identification of distinct trajectory patterns not only underscores the heterogeneity in sepsis but also emphasizes the importance of personalized management strategies. The findings underscore the potential of VIS trajectory monitoring in predicting 28-day outcomes and in guiding clinical decision-making in ICU settings.
期刊介绍:
Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.