因 COVID-19 而接受体外膜肺氧合治疗的患者中的免疫调节剂:ELSO 登记的倾向分数调整分析。

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Ryan Ruiyang Ling, Kollengode Ramanathan, Liang Shen, Ryan P Barbaro, Kiran Shekar, Daniel Brodie, Graeme MacLaren
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引用次数: 0

摘要

背景:在COVID-19大流行期间,接受体外膜肺氧合(ECMO)治疗的患者死亡率上升。我们研究了免疫调节剂与因 COVID-19 而接受 ECMO 的患者死亡率之间的关系:我们回顾性分析了体外生命支持组织从 2020 年 1 月 1 日至 2021 年 12 月 31 日的登记资料,比较了未使用免疫调节剂、仅使用皮质类固醇、仅使用其他免疫调节剂(选择性白细胞介素阻断剂、破伤风激酶抑制剂、康复血浆和静脉注射免疫球蛋白)以及在 ECMO 之前或期间联合使用皮质类固醇和其他免疫调节剂的患者的预后。我们使用 Cox 回归模型来估算 90 天前的存活时间。我们使用多项式回归估算了接受不同免疫调节剂的倾向得分,并将这些得分纳入回归模型:我们在最终分析中纳入了 7181 名患者,其中 6169 名患者在 ECMO 之前或期间接受了免疫调节剂。未使用免疫调节剂的患者 90 天生存率为 58.1%(95%-CI 55.1-61.2%),仅使用皮质类固醇的患者 90 天生存率为 50.7%(95%-CI 49.0-52.5%),使用其他免疫调节剂的患者 90 天生存率为 62.2%(95%-CI 57.4-67.0%),使用皮质类固醇和其他免疫调节剂的患者 90 天生存率为 48.5%(95%-CI 46.7-50.4%)。与未使用免疫调节剂的患者相比,单独使用皮质类固醇(HR:1.13,95%-CI:1.01-1.28)或同时使用其他免疫调节剂(HR:1.21,95%-CI:1.07-1.54)的患者生存时间明显较短,而仅使用其他免疫调节剂的患者生存时间明显较长(HR:0.79,95%-CI:0.66-0.96)。接受免疫调节剂(所有三组)与继发感染的增加有关:在这项队列研究中,我们发现免疫调节剂,尤其是皮质类固醇,与因 COVID-19 而接受 ECMO 的患者死亡率显著升高有关,这是在调整了潜在混杂变量和倾向评分后得出的结论。此外,无论是否使用其他免疫调节剂,接受皮质类固醇治疗的患者的 ECMO 运行时间都更长,这对资源分配有潜在影响。虽然可能仍存在残余混杂因素,但仍需进一步研究,以评估使用免疫调节剂的时机,并更好地了解这种关联背后的可能机制,包括继发性感染。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Immunomodulators in patients receiving extracorporeal membrane oxygenation for COVID-19: a propensity-score adjusted analysis of the ELSO registry.

Immunomodulators in patients receiving extracorporeal membrane oxygenation for COVID-19: a propensity-score adjusted analysis of the ELSO registry.

Background: Mortality for patients receiving extracorporeal membrane oxygenation (ECMO) for COVID-19 increased over the course of the pandemic. We investigated the association between immunomodulators and mortality for patients receiving ECMO for COVID-19.

Methods: We retrospectively analysed the Extracorporeal Life Support Organisation registry from 1 January, 2020, through 31 December, 2021, to compare the outcomes of patients who received no immunomodulators, only corticosteroids, only other immunomodulators (selective interleukin blockers, janus-kinase inhibitors, convalescent plasma, and intravenous immunoglobulin), and a combination of corticosteroids and other immunomodulators administered either before or during ECMO. We used Cox regression models to estimate survival time until 90 days. We estimated the propensity score of receiving different immunomodulators using multinomial regression, and incorporated these scores into the regression models.

Results: We included 7181 patients in the final analysis; 6169 patients received immunomodulators either before or during ECMO. The 90-day survival was 58.1% (95%-CI 55.1-61.2%) for patients receiving no immunomodulators, 50.7% (95%-CI 49.0-52.5%) for those receiving only corticosteroids, 62.2% (95%-CI 57.4-67.0%) for those receiving other immunomodulators, and 48.5% (95%-CI 46.7-50.4%) for those receiving corticosteroids and other immunomodulators. Compared to patients without immunomodulators, patients receiving either corticosteroids alone (HR: 1.13, 95%-CI 1.01-1.28) or with other immunomodulators (HR: 1.21, 95%-CI: 1.07-1.54) had significantly shorter survival time, while patients receiving only other immunomodulators had significantly longer survival time (HR: 0.79, 95%-CI: 0.66-0.96). The receipt of immunomodulators (across all three groups) was associated with an increase in secondary infections.

Conclusions: In this cohort study, we found that immunomodulators, in particular corticosteroids, were associated with significantly higher mortality amongst patients receiving ECMO for COVID-19, after adjusting for potential confounding variables and propensity score. In addition, patients receiving corticosteroids with or without other immunomodulators had longer ECMO runs, which has potential implications for resource allocation. While residual confounding likely remains, further studies are required to evaluate the timing of immunomodulators and better understand the possible mechanisms behind this association, including secondary infections.

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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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