血管紧张素II、常规血管加压治疗和休克死亡率:一项大型、多中心、倾向评分加权分析。

IF 5.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Laurence W Busse, Caitlin Ten Lohuis, Han Xu, Cooper Jannuzzo, Robert H Lyles, J Pedro Teixeira, Ishan Mehta, Yuan Liu
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引用次数: 0

摘要

背景:在休克患者中,血管紧张素II (Ang II)通常与肾上腺素能药物和血管加压素(常规治疗)一起使用,但其是否能改善预后尚不清楚。研究问题:我们评估了在常规治疗中加入不同去甲肾上腺素当量(NE)剂量的Ang II是否与死亡率相关。方法:我们对在单一医疗保健系统的四个中心接受血管加压药物治疗休克的811例患者进行了回顾性分析,其中275例接受Ang II加常规治疗,536例仅接受常规治疗。年龄、性别、序贯器官衰竭评估评分、血清乳酸、NE背景剂量、皮质类固醇使用、发病前血管紧张素转换酶抑制剂或血管紧张素受体阻阻剂使用和Charlson合并症指数在Ang II开始时或在常规治疗队列的等效锐度时计算。我们使用倾向评分和治疗加权逆概率(IPTW)来实现共变量平衡和多变量逻辑回归来比较30天死亡率,并进一步以0.10微克/千克/分钟NE增量对患者进行分层。结果:30天总死亡率为56.4%。各组在所有基线变量上均有统计学差异。在多变量logistic回归中,与单纯常规治疗相比,Ang II治疗的30天死亡率较低(优势比[OR] 0.65, 95%可信区间[CI] 0.45-0.95, p = 0.025)。IPTW后,Ang II的使用与较低的死亡率独立相关(OR 0.74, 95% CI 0.55-0.99, p = 0.040)。当按背景NE剂量增量分层时,与常规治疗相比,背景NE剂量> 0.4、> 0.5和≤0.6 mcg/kg/min的患者,Ang II启动与较低的30天死亡率相关。背景NE剂量为>.6的患者使用Ang II与死亡率无显著相关性。结论:在未调整和调整分析中,Ang II给药与较低的死亡风险相关。只有当患者接受剂量为0.4 - 0.6 mcg/kg/min的NE时,这种效果才得以保留。虽然还需要进一步的前瞻性研究,但这些发现表明,Ang II可能在特定的背景血管加压剂剂量范围内是有益的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Angiotensin II, conventional vasopressor therapy, and mortality in shock: a large, multicenter, propensity score-weighted analysis.

Background: Angiotensin II (Ang II) is typically used in addition to adrenergic agents and vasopressin (conventional therapy) in patients with shock, but whether its use improves outcomes is unknown.

Research question: We evaluated whether Ang II, when added to conventional therapy at different norepinephrine equivalent (NE) doses, was associated with mortality.

Methods: We performed a retrospective analysis of 811 patients admitted to four centers in a single healthcare system who received vasopressors for shock, including 275 who received Ang II plus conventional therapy and 536 who received only conventional therapy. Age, gender, sequential organ failure assessment score, serum lactate, background NE dose, corticosteroid use, pre-morbid angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and Charlson Comorbidity Index were calculated at initiation of Ang II or at an equivalent point of acuity in the conventional therapy cohort. We used propensity scores with inverse probability of treatment weighting (IPTW) to achieve covariate balance and multivariable logistic regression to compare 30-day mortality, further stratifying patients by 0.10 mcg/kg/min NE increments.

Results: Overall 30-day mortality was 56.4%. Groups statistically differed by all baseline variables. In multivariable logistic regression, Ang II treatment was associated with lower 30-day mortality compared to conventional therapy alone (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.45-0.95, p = 0.025). After IPTW, Ang II use was independently associated with lower mortality (OR 0.74, 95% CI 0.55-0.99, p = 0.040). When stratifying by increments of background NE dose, Ang II initiation was associated with lower 30-day mortality compared to conventional therapy alone in patients on background NE doses > 0.4, > 0.5, and ≤ 0.6 mcg/kg/min. Ang II use in patients on background NE dose > 0.6 was not significantly associated with mortality.

Conclusions: Ang II administration was associated with a lower risk of death in unadjusted and adjusted analyses. This effect was preserved only with patients receiving NE at doses ranging from 0.4 to 0.6 mcg/kg/min. Though additional prospective studies are required, these findings suggest that Ang II may be beneficial across a specific range of background vasopressor doses.

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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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