[探索败血症患者脉搏氧饱和度的最佳范围:基于 MIMIC- IV 数据的回顾性研究]。

Q3 Medicine
Yuanwen Ye, Feifei Li, Baohua Yang, Liangen Lin, Linglong Chen
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引用次数: 0

摘要

目的:探讨败血症患者住院期间的最佳脉搏氧饱和度(SpO2)范围:探讨败血症患者住院期间的最佳脉搏氧饱和度(SpO2)范围:采用病例对照研究设计。从重症监护医学信息市场-IV(MIMIC- IV)中提取脓毒症患者的人口统计学信息、生命体征、合并症、实验室参数、危重病评分、临床治疗信息和临床结果。采用广义加法模型(GAM)结合卢斯平滑函数分析住院期间SpO2水平与院内全因死亡率之间的非线性关系,并将其可视化。确定了 SpO2 的最佳范围,并利用 Logistic 回归模型和 Kaplan-Meier 曲线验证了确定的 SpO2 范围与住院全因死亡率之间的关系:共有 5 937 名患者符合纳入标准,其中 1 191 人(20.1%)在住院期间死亡。GAM分析显示,SpO2水平与脓毒症患者住院期间的院内全因死亡率之间存在非线性U型关系。多变量逻辑回归分析进一步证实,住院期间SpO2水平在0.96和0.98之间的患者死亡率低于SpO2<0.96(低氧组;比值比(OR)=2.659,95%置信区间(95%CI)为2.190-3.229,P<0.001)和SpO2>0.98(高氧组;OR=1.594,95%CI为1.337-1.900,P<0.001)的患者。Kaplan-Meier 生存曲线显示,住院期间 SpO2 在 0.96 和 0.98 之间的患者的生存概率高于 SpO2 < 0.96 和 SpO2 > 0.98 的患者(Log-Rank 检验:χ 2 = 113.400,P < 0.001)。敏感性分析表明,除样本量较小的亚组外,在年龄、性别、体重指数 (BMI)、入院类型、种族、心率、收缩压、舒张压、平均动脉压、呼吸频率、体温、心肌梗死、充血性心力衰竭、脑卒中、心肌梗死、心肌梗死、心肌梗死、心肌梗死、心肌梗死、心肌梗死、心肌梗死、心肌梗死、心肌梗死、心肌梗死、心肌梗死、心肌梗死根据SpO2介于0.96和0.98之间的患者的死亡率显著低于SpO2介于0.96和0.98之间的患者。SpO2在0.96和0.98之间的患者死亡率明显低于SpO2<0.96和SpO2>0.98的患者:结论:在住院期间,脓毒症患者的 SpO2 水平与院内全因死亡率呈 "U "型关系,表明血氧水平升高和降低都与死亡风险增加有关。最佳的 SpO2 范围被确定为 0.96 至 0.98。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Exploring the optimal range of pulse oxygen saturation in patients with sepsis: a retrospective study based on MIMIC- IV data].

Objective: To explore the optimal pulse oxygen saturation (SpO2) range during hospitalization for patients with sepsis.

Methods: A case-control study design was employed. Demographic information, vital signs, comorbidities, laboratory parameters, critical illness scores, clinical treatment information, and clinical outcomes of sepsis patients were extracted from the Medical Information Mart for Intensive Care- IV (MIMIC- IV). A generalized additive model (GAM) combined with a Loess smoothing function was employed to analyze and visualize the nonlinear relationship between SpO2 levels during hospitalization and in-hospital all-cause mortality. The optimal range of SpO2 was determined, and Logistic regression model along with Kaplan-Meier curve were utilized to validate the association between the determined range of SpO2 and in-hospital all-cause mortality.

Results: A total of 5 937 patients met the inclusion criteria, among whom 1 191 (20.1%) died during hospitalization. GAM analysis revealed a nonlinear and U-shaped relationship between SpO2 levels and in-hospital all-cause mortality among sepsis patients during hospitalization. Multivariable Logistic regression analysis further confirmed that patients with SpO2 levels between 0.96 and 0.98 during hospitalization had a decreased mortality compared to those with SpO2 < 0.96 [hypoxia group; odds ratio (OR) = 2.659, 95% confidence interval (95%CI) was 2.190-3.229, P < 0.001] and SpO2 > 0.98 (hyperoxia group; OR = 1.594, 95%CI was 1.337-1.900, P < 0.001). Kaplan-Meier survival curve showed that patients with SpO2 between 0.96 and 0.98 during hospitalization had a higher probability of survival than those patient with SpO2 < 0.96 and SpO2 > 0.98 (Log-Rank test: χ 2 = 113.400, P < 0.001). Sensitivity analyses demonstrated that, with the exception of subgroups with smaller sample sizes, across the strata of age, gender, body mass index (BMI), admission type, race, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, body temperature, myocardial infarction, congestive heart failure, cerebrovascular disease, chronic liver disease, diabetes mellitus, sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPS II), systemic inflammatory response syndrome score (SIRS), and Glasgow coma score (GCS), the mortality of patients with SpO2 between 0.96 and 0.98 was significantly lower than those of patients with SpO2 < 0.96 and SpO2 > 0.98.

Conclusions: During hospitalization, the level of SpO2 among sepsis patients exhibits a U-shaped relationship with in-hospital all-cause mortality, indicating that heightened and diminished oxygen levels are both associated with increased mortality risk. The optimal SpO2 range is determined to be between 0.96 and 0.98.

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来源期刊
Zhonghua wei zhong bing ji jiu yi xue
Zhonghua wei zhong bing ji jiu yi xue Medicine-Critical Care and Intensive Care Medicine
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