药物使用障碍对感染性青少年重症监护管理和健康结局的影响

IF 5.7 1区医学 Q1 CRITICAL CARE MEDICINE

Annals of Intensive Care Pub Date : 2025-05-10 DOI:10.1186/s13613-025-01482-8

Havell Markus, Gary D Ceneviva, Neal J Thomas, Conrad Krawiec

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引用次数: 0

摘要

背景：药物滥用障碍（SUD）的成年脓毒症患者预后不良的风险增加，但对青少年的影响尚不清楚。我们的目的是确定在因败血症住院的危重青少年中，预先存在的SUD是否与不良结局和危重监护资源的增加有关。我们假设，在这一青少年患者群体中，SUD与不良后果的风险增加和重症监护资源的使用有关。方法：这是一项回顾性队列研究，利用TriNetX©电子健康记录（EHR）数据库，该数据库由主要来自美国的参与医疗机构的EHR组成。12 ~ 21岁的重症脓毒症青少年分为两组（有SUD史和无SUD史）。分析与人口统计学、诊断、程序和药物编码相关的数据。主要结局是器官功能障碍、重症监护治疗和全因1年死亡率。结果：我们纳入了5436例患有脓毒症的危重青少年[其中730例（13.43%）有SUD病史，4706例（86.57%）无SUD病史]。SUD病史与器官功能障碍的几率增加相关(调整优势比[aOR] 1.84；95%置信区间[CI] 1.56-2.16；结论：我们的回顾性分析表明，青少年重症脓毒症患者的SUD病史与重症监护资源的利用率增加和器官功能障碍有关。需要进一步的研究来确定药物滥用是否代表青少年患者危重疾病的潜在可改变的风险因素。

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Impact of substance use disorders on critical care management and health outcomes in septic adolescents.

Background: Adult septic patients with substance abuse disorder (SUD) are at increased risk of poor outcomes, but the impact on adolescents is unknown. We aimed to determine if pre-existing SUD is associated with increased adverse outcomes and critical care resources in critically ill adolescents hospitalized with sepsis. We hypothesize that SUD is associated with increased risk of adverse outcomes and usage of critical care resources in this adolescent patient population.

Methods: This was a retrospective cohort study utilizing the TriNetX© electronic health record (EHR) database, which consists of EHR from participating healthcare organizations predominantly in the United States. Critically ill adolescents with sepsis aged 12-21 years were divided into two groups (SUD history and no-SUD history). Data related to demographics, diagnostic, procedural, and medication codes were analyzed. The primary outcomes were organ dysfunction, critical care therapies, and all-cause 1-year mortality.

Results: We included 5,436 critically ill adolescents with sepsis [730 (13.43%) SUD history and 4706 (86.57%) no-SUD history]. SUD history was associated with increased odds of organ dysfunction (adjusted odds ratio [aOR] 1.84; 95% confidence interval [CI] 1.56-2.16; p < 0.001), vasoactive/inotropic drug usage (aOR 1.29; 95% CI 1.10-1.52; p = 0.002), mechanical ventilation (aOR 2.19; 95% CI 1.85-2.59; p < 0.001), but not mortality (aOR 1.03; 95% CI 0.76-1.41; p = 0.83).

Conclusions: Our retrospective analysis suggests history of SUD in critically ill septic adolescent patients is associated with increased utilization of critical care resources and organ dysfunction. Further study is needed to determine if substance abuse represents a potentially modifiable risk factor for critical illness in adolescent patients.

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来源期刊

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.